FOX FINANCE LC CREDIT APPLICATION

							                              FOX FINANCE, LC CREDIT APPLICATION

                                                   For Office Use Only
         Date___________          Amt $________ Referral _____________ Customer Acct # ___________

Name: ______________________________________________________ Date of Birth: ________/ __________/ ___________

State ID or License # ________________________________________ State ______               SS # ________- ______- _________

Address: __________________________________________________City ___________________ State ____Zip___________

Phone Number: _____________________ Cell Phone-Pager: _____________________ E-mail __________________________

How much money do you want to borrow? $__________           How did you hear about us? ________________________________

Are you in the military? ______     Do you work? ______     Do you get social security? ______ Do you get a pension? ______

Employers Name or Income Source: _____________________________________ Phone # __________________Ext: _______

Address: _______________________________________________________________City _________________State _______

How much do you make each check? $____________           Hire Date: ______________________Title: _____________________

Do you get Direct Deposit? ( ) Yes, to bank account     ( ) Yes, to Debit Card    ( ) Yes, to Government Card     ( ) No

Bank Name: ___________________________ Routing # ______________________ Acct # ____________________________

Have you ever filed bankruptcy? ______ What Chapter? _____ When did you file? __________ Discharge Date__________

How do you get paid? ( ) Every Week ( ) Every 2 Weeks ( ) Monthly ( ) Twice a Month             ( ) Other __________________

If you get paid every week or every 2 weeks, what day is your payday? ( ) Mon ( ) Tues ( ) Wed ( ) Thurs ( ) Fri

If you get paid once or twice a month, what is the date or the dates you get paid? (Dates) _______________ & _____________

Do You: ( ) Rent ( ) Own ( ) Live with Family How long have you lived there? ______________ Amt Paid $___________

Name of Landlord, Family Member or Mortgage Company ______________________________ Phone # ________________

Previous Address ________________________________________________________________________________________

4 Personal References (at least 3 should be family members, please include area code)

Name: ___________________________________________ Relationship_________________ Phone # __________________

Name: ___________________________________________ Relationship_________________ Phone # __________________

Name: ___________________________________________ Relationship_________________ Phone # __________________

Name: ___________________________________________ Relationship_________________ Phone # __________________

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this
application whether or not it is approved. You are authorized to check my references, my credit and employment history and to
answer questions about your credit experience with me. The above statements are made for the sole purpose of obtaining money
on credit and I hereby warrant same to be true with full knowledge that if any of said statements are not true, and money is
obtained I will be guilty of having obtained money on credit by means of material false written representations and under false
pretenses.

Applicants Signature: ____________________________________________________________ Date____________________