Consumer Credit Application | Bradigan's Incorporated

Bradigan's, Inc. Consumer Credit Application

	** Required Fields
**Type of Service:
1. PERSONAL INFORMATION
**Full Name:
**Email:
**Street Address:
City, State, **ZIP:	,
**How Long at This Address?	Own or Rent? Own Rent
**Type of Car:	**Year:
2. EMPLOYMENT INFORMATION
**Employer:
**Position:
**How Long with This Employer?
**Number of Dependants:
3. OTHER INCOME AND OBLIGATIONS
Other Sources of Income:	$ Other Sources of Income: $ Other Sources of Income: $
Outstanding Obligations:	$ Outstanding Obligations: $ Outstanding Obligations: $ Outstanding Obligations: $
Pending Lawsuits:
**Have you filed bankruptcy in the last 3 years?	No Yes
4. REFERENCES
Credit References:
**Name:	Address:
**Name:	Address:
**Name:	Address:
**Bank Name:
**Bank Address:
**Account Types Held:	Savings Checking
5. NOTICE
	When making application for credit, it is understood that an investigation may be made whereby information is obtained through personal interviews with your neighbors, friends, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living. You have a right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigation. I certify that all of the information I have provided is correct, and that I have read and understood the NOTICE statement listed above.


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