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Loan Application - AMG Finance of LaGrange

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CREDIT APPLICATION

Alimony, child support or separate maintenance income need not be reported if you do not wish to have it considered as a basis for repaying this obligation

Loan Information

INFORMATION REGARDING APPLICATION
Branch
Amount of loan		Purpose of Loan
How did you hear about us?
First Name		Last Name
Date of Birth		Social Security #
Email		Contact Phone
Address		City
Zip		State
Residence Type		Other Residence
Monthly Payment		Time at Residence

Employment Information

Employer
Employer		Employer's Phone
Time at Employer		Position
Pay Day		Net Pay Per Check

Income

Additional Income Information (if applicable)
Rental Income		P/T Income
Alimony/Child Support		SSI
Pension		Disability
Social Security Income (not SSN)		Other
		Income Total

INFORMATION REGARDING SP0USE, JOINT APPLICANT, USER OR OTHER PARTY
Last Name		First Name
Social Security #		Date of Birth
Email		Contact Phone
Employer		Employer's Phone
Time at Employer		Position
Pay Day		Net Pay Per Check

Debts & Creditors (if applicable)

List all creditors and debt		Payments





Total

Car Info (if applicable)


Make		Model
Year		Payments

Total Monthly Living Expenses

(examples: electric, phone, or groceries)
Total

Everything that I have stated in this application is correct. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit, employment history and to answer any questions about your credit experience with me. You are authorized to contact references I provide in an attempt to locate me, to contact me by telephone, text, email, or letter at my telephone numbers (including cell phone, home phone and work phone), email address, and visit me at my physical home address to solicit me or collect on my account.
Applicant E-Signature		Date

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