Credit America Credit Application

This form is for a single applicant.

If you will be using a Co-Signer, Do Not Complete this application. Click the button

'Buyer/Co-Signer' and complete that application.

* Required

Applicant
*First Name:
*Last Name:
*Social Security Number:
*Date of Birth (mm/dd/yyyy):
*Email Address
*Home Phone Number:
*Street Address:
*City:
*State:
*Zip:
*How long have you live at the current address?
*Driver's License Number:
*State:
*Expiration Date (mm/dd/yyyy):
Residence
*Do you:
If other, explain:
Mortgage Holder / Landlord
Mortgage Holder / Landlord Phone Number:
*Monthly Payment:
Employment
*Employer:
*How long have you been at your current employer?
Employment Address:
*Net Monthly Income (after taxes):
*How often do you get paid?
Your Job Title:
Your Supervisor's Name:
Banking Information
*Name of Bank:
Do you have a:
Other Income Source:
Have you ever filed for bankruptcy?
Has it been discharged?
What year was it discharged?

I authorize the Creditor to make whatever inquiries it deems necessary in connection with the credit application and the course of review or collection of any creditor extended in reliance on this application. I further authorize any person or Consumer Reporting Agency to complete and furnish to the Creditor any information that it may have or obtain in response to such inquiries, and agree that such information along with this application, shall remain the Creditor's property, whether or not credit is extended.

THIS UNDERSIGNED REPRESENTS THAT ALL OTHER INFORMATION CONTAINED IN THIS APPLICATION FOR CREDIT IS TRUE, COMPLETE AND CORRECT. THE UNDERSIGNED UNDERSTANDS THAT GENERAL FINANCE & ACCEPTANCE CORPORATION WILL RELY ON THE TRUTH OF FOREGOING STATEMENTS IN GRANTING CREDIT TO THE UNDERSIGNED.

I AGREE TO THE ABOVE