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									                                                                                                                                                                                   2100 South Olive Street
                                                                                                                                                                               Pine Bluff, Arkansas 71601
                                                                                                                                                                                    Phone (870) 535-7600
                                                                                         RETAIL                BALLOON                  LEASE
                                                                                                                                                                                      Fax: (870) 535-7750
                                                                                                                                                                            www.arkansasfinancecenter.com
                          CREDIT APPLICATION

              Individual Credit - Applying for credit in your own name and are relying on income or assets, and not the income or assets of another person as the basis for
              re-payment of the credit requested.
               Joint Credit - Applying for joint credit with another person. Relationship to applicant:                   Spousal              Non-Spousal
              Individual Credit Relying on Other Income - Applying for credit in your own name but relying on income for alimony, child support and
              seperate maintainance or on income or assets of another person for re-payment of credit requested
              Note: If married, the spouse is not required to be the JOINT applicant.

   DEALER NAME & NUMBER:                                                                                 CONTACT NAME:
                           APPLICANT INFORMATION                                                                          JOINT-APPLICANT INFORMATION
                LAST                               FIRST                     MIDDLE INIT.                           LAST                               FIRST                     MIDDLE INIT.


     DATE OF BIRTH                             SSN                        HOME PHONE #                  DATE OF BIRTH                              SSN                        HOME PHONE #


    STREET ADDRESS                  CITY               STATE              ZIP                           STREET ADDRESS                  CITY               STATE              ZIP


  HOW LONG AT ADDRESS?                     MTG OR RENT             RESIDENTIAL STATUS:                HOW LONG AT ADDRESS?                     MTG OR RENT             RESIDENTIAL STATUS:
                                            PAYMENT $            OWN         LIVE W/ PARENTS                                                    PAYMENT $            OWN         LIVE W/ PARENTS
                                                                 RENT        OTHER                                                                                   RENT        OTHER
                 PREVIOUS ADDRESS                                       YEARS       MONTHS                           PREVIOUS ADDRESS                                       YEARS       MONTHS
     (IF LESS THAN 2 YEARS AT PRESENT ADDRESS)                                                           (IF LESS THAN 2 YEARS AT PRESENT ADDRESS)


                 EMPLOYER                                EMPLOYER PHONE NUMBER                                       EMPLOYER                                EMPLOYER PHONE NUMBER


               JOB TITLE / OCCUPATION                                   YEARS       MONTHS                        JOB TITLE / OCCUPATION                                    YEARS        MONTHS


        GROSS MONTHLY                                    EMPLOYER’S ADDRESS                                  GROSS MONTHLY                                   EMPLOYER’S ADDRESS
           SALARY                                                                                               SALARY

 PREVIOUS EMPLOYER NAME, ADDRESS, PHONE # AND LENGTH OF EMPLOYMENT                                   PREVIOUS EMPLOYER NAME, ADDRESS, PHONE # AND LENGTH OF EMPLOYMENT
             (IF LESS THAN 2 YEARS WITH PRESENT EMPLOYER)                                                        (IF LESS THAN 2 YEARS WITH PRESENT EMPLOYER)


OTHER INCOME NOTE: Alimony, child support, or seperate maintenance income need not be revealed if you do not wish
                       it considered as a basis for repaying this loan.
APPLICANT- SOURCE OF                    (A) AMOUNT $ MONTHLY            JOINT-APPLICANT-SOURCE OF OTHER                   (B) AMOUNT $ MONTHLY           TOTAL OTHER $ MONTHLY (INCL. A&B)
OTHER INCOME                                                            INCOME

  INDICATE RELATIONSHIP OR OWNERSHIP OF ACCOUNT BY X-ING THE APPROPRIATE LETTER: A = APPLICANT, B = JOINT-APPLICANT, & J = JOINT

NEAREST RELATIVE                                                                                        A             B           J        RELATIVE’S
NAME AND ADDRESS                                                                                                                           PHONE NO. (          )
NEAREST RELATIVE                                                                                                                           RELATIVE’S
                                                                                                         A            B             J
NAME AND ADDRESS                                                                                                                           PHONE NO. (          )
NEAREST RELATIVE                                                                                                                           RELATIVE’S
                                                                                                         A            B             J      PHONE NO. (          )
NAME AND ADDRESS
NEAREST RELATIVE                                                                                         A            B             J      RELATIVE’S
NAME AND ADDRESS                                                                                                                           PHONE NO. (          )
You represent that all information in this application is accurate and complete, that you are competent to enter into contracts, that no bankruptcy proceeding is in progress or anticipated which
involves you and that no additional applications for credit with another lender have recently been submitted or will be submitted by you prior to our consideration of this application. We are not ob-
ligated to grant you credit and we may retain this application whether or not credit is granted. You agree to pay all fees in connection with this application and your loan. You authorize us to obtain
information from others concerning your credit standing and other relevant information impacting on this application and to provide to others information about our experience with you. Except as
otherwise prohibited by law, you agree and consent that we, Arkansas Finance Center LLC , may share all information about you that Arkansas Finance Center has or may obtain for, among other
things, the purposes of evaluating credit applications or offering you products or services including insurance products that Arkansas Finance Center believes may be of interest to you.

APPLICANT
SIGNATURE _________________________________________ DATE _______________                             JOINT-APPLICANT SIGNATURE ________________________________ DATE ____________

  DEALER USE ONLY
                    YEAR             MAKE              MODEL            MILEAGE (USED ONLY)         CASH PRICE:
  NEW USED                                                                                                    INCL. TAX, TITLE, REG AND FEES                        $ __________________________
  DEMO                                                                                              DOWN PAYMENT:
                                                                                                              CASH / NET TRADE                                      $ __________________________
                    YEAR             MAKE              MODEL                    MILEAGE
                                                                                                              REBATE                                                $ __________________________
  TRADE-IN                                                                                          UNPAID BALANCE OR CAP COST:                                     $ __________________________
                   AMOUNT $         OWED $           PAYMENT $             FINANCED WITH...            INVOICE $ OR MSRP                 TERM                APR OR FACTOR                  PMT $

								
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