FIDELITY FINANCE
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Credit Application

Loan Application

Applicant Information
Loan Amount Requested:
First Name:
Middle Initial:
Last Name:
SSN:
Date of Birth:
Married, Unmarried, Separated:
Buying, Renting, Board:
Amount Monthly:
Current Mailing Address:
Current Physical Address:
City:
Zip Code:	(5 digits)
State:
Previous Physical Address:	(if less than 1 year)
Co-Applicant Information
First Name:
Middle Initial:
Last Name:
SSN:
Current Mailing Address:
Current Physical Address:
City:
Zip Code:	(5 digits)
State:
Previous Physical Address:	(if less than 1 year)
How Long:
City:
Zip Code:
State:
Contact Information
Daytime Phone:
Cell Phone:
Evening Phone:
Email:
Employment Info:
Employer Name :
Employer Phone:
How long:
Current Net Income:
Position/Title:
Additional Income:
Other Information
Comments:	Enter comments here!
Security Code: *
	By submitting this application you understand and agree that you are applying for credit with Fidelity Finance by providing information to complete and submit this credit application. You certify that all information on the application submitted to Fidelity Finance is true and complete. You understand that Fidelity Finance will retain this application whether or not it is approved. Fidelity Finance is authorized to check my credit, employment history, assets, other debts, and other references. You understand that any false statements may subject you to criminal penalties. This authorization and release of liability shall not end with the passing of time.