Credit Application

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MUTUAL FINANCE, INC.
(601) 948-1284

Section A: Applicant Information

Have You ever filed Bankruptcy?
yes no

INCOME FROM ALIMONY, CHILD SUPPORT, OR MAINTENANCE NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO RELY UPON IT AS A BASIS FOR REPAYING THIS OBLIGATION
Alimony, child support, seperate maintenance received under: COURT ORDER WRITTEN AGREEMENT ORAL UNDERSTANDING

Marital Status
(DO NOT COMPLETE IF THIS IS AN APPLICATION FOR INDIVIDUAL UNSECURED CREDIT)
APPLICANT MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED)
OTHER PARTY: MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED)

CREDIT REFERENCES

Name Of Creditors

Section B: Joint Applicant Or Other Party Information Information

Have You ever filed Bankruptcy?
yes no

CREDIT REFERENCES

Name Of Creditors

I/We hereby certify that the foregoing statements are true and complete and are made for the purpose of determining my/our eligibility for credit. I/We agree that this statement shall remain your property, whether or not the application is accepted. You are authorized to make all inquiries you deem necessary to verify the accuracy of the statements made herein, and to determine my/our credit worthiness, including, but not limited to, procuring consumer reports from the consumer reporting agencies and credit information from the banks and other financial institutions and extenders of credit, references, present and former employers, merchants, landlords and creditors. Each applicant consents that, upon denial of the application based upon a consumer report or information received from a person other than a consumer reporting agency on any applicant creditor may make appropriate Fair Credit Reporting Act disclosures to all applicants.

Date:	Amount Requested:	# Of Months Financed:		Seller:
Section A: Applicant Information
First Name:	Middle:	Last:		Have You ever filed Bankruptcy? yes no
Address:	City:	State:	Zip Code:	How Long?	Dependents
Birth Date:	Social Security Number:	Home Phone:		Cell Phone:
Previous Address:	City:	State:	Zip Code:	How Long?

Employer's Name:	Employer's Address:	State:	Zip Code:	How Long ?
Employer's Phone #	Position Held:	Dept:	Gross Salary: weekly monthly
Previous Employer:	How Long ?	Name of Bank Checking:		Name of Bank Savings:
INCOME FROM ALIMONY, CHILD SUPPORT, OR MAINTENANCE NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO RELY UPON IT AS A BASIS FOR REPAYING THIS OBLIGATION Alimony, child support, seperate maintenance received under: COURT ORDER WRITTEN AGREEMENT ORAL UNDERSTANDING
Other Source Income:	Monthly Amount:	Do You make Alimony, Child Support, or Maintenance Payments? yes no		Monthly Amount:
Mother, Father, Or Relative	Relationship:	Address:		Phone:
Other Relative or Friend:	Relationship:	Address:		Phone:
Marital Status (DO NOT COMPLETE IF THIS IS AN APPLICATION FOR INDIVIDUAL UNSECURED CREDIT) APPLICANT MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED) OTHER PARTY: MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED)
Own Home Rent Live with Relative	Name of Mortgage Holder, Landlord, Or Relative:			Monthly Payment

Auto Owned: Year, Make, Model:				Monthly Payment
CREDIT REFERENCES
Name Of Creditors	Check One	Monthly Payment		Balance
	open paid
	open paid
	open paid
	open paid
	open paid
	open paid
	open paid
	open paid
Section B: Joint Applicant Or Other Party Information Information
First Name:	Middle:	Last:		Have You ever filed Bankruptcy? yes no
Address:	City:	State:	Zip Code:	How Long?	Dependents
Birth Date:	Social Security Number:	Home Phone: example: (601) 555-5555		Cell Phone:
Previous Address:	City:	State:	Zip Code:	How Long?

Employer's Name:	Employer's Address:	State:	Zip Code:	How Long ?
Employer's Phone #	Position Held:	Dept:	Gross Salary: weekly monthly
Previous Employer:	How Long ?	Name of Bank Checking:		Name of Bank Savings:
INCOME FROM ALIMONY, CHILD SUPPORT, OR MAINTENANCE NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO RELY UPON IT AS A BASIS FOR REPAYING THIS OBLIGATION Alimony, child support, seperate maintenance received under: COURT ORDER WRITTEN AGREEMENT ORAL UNDERSTANDING
Other Source Income:	Monthly Amount:	Do You make Alimony, Child Support, or Maintenance Payments? yes no		Monthly Amount:
Mother, Father, Or Relative	Relationship:	Address:		Phone:
Other Relative or Friend:	Relationship:	Address:		Phone:
Marital Status (DO NOT COMPLETE IF THIS IS AN APPLICATION FOR INDIVIDUAL UNSECURED CREDIT) APPLICANT MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED) OTHER PARTY: MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED)
Own Home Rent Live with Relative	Name of Mortgage Holder, Landlord, Or Relative:			Monthly Payment

Auto Owned: Year, Make, Model:				Monthly Payment
CREDIT REFERENCES
Name Of Creditors	Check One	Monthly Payment		Balance
	open paid
	open paid
	open paid
	open paid
	open paid
	open paid
	open paid
	open paid
I/We hereby certify that the foregoing statements are true and complete and are made for the purpose of determining my/our eligibility for credit. I/We agree that this statement shall remain your property, whether or not the application is accepted. You are authorized to make all inquiries you deem necessary to verify the accuracy of the statements made herein, and to determine my/our credit worthiness, including, but not limited to, procuring consumer reports from the consumer reporting agencies and credit information from the banks and other financial institutions and extenders of credit, references, present and former employers, merchants, landlords and creditors. Each applicant consents that, upon denial of the application based upon a consumer report or information received from a person other than a consumer reporting agency on any applicant creditor may make appropriate Fair Credit Reporting Act disclosures to all applicants.