Application for Financing FIRST NAME MIDDLE NAME LAST NAME STREET ADDRESS APARTMENT/UNIT CITY STATE ZIP CODE SSN CELL PHONE HOME PHONE EMAIL ADDRESS SOCIAL MEDIA If you have any of the listed social media accounts, please list the information below. If you do not have the listed social media, please enter "N/A". Please note that these fields are required and subject to verification. If it is found that you have a social media account and did not list it here, your application may be denied. FACEBOOK USER NAME INSTAGRAM USER NAME X User Name SNAPCHAT USER NAME WHATSAPP USER NAME EMPLOYMENT INFORMATION EMPLOYER NAME EMPLOYER ADDRESS CITY STATE ZIP CODE JOB TITLE LENGTH OF TIME AT EMPLOYER EMPLOYER PHONE NUMBER WORK EMAIL ADDRESS HOW OFTEN ARE YOU PAID? WeeklyBi-WeeklyBi-MonthlyMonthly SALARY OR HOURLY? SALARYHOURLY SALARY AMOUNT or HOURLY WAGE FINANCING INFORMATION Is this financing application for your license? YESNO If you answered No, who's license is the financing application for? Applicant's Driver's License Number Driver's License Number for Person Requiring Restoration (if not the Applicant) Do you have outstanding traffic tickets that need to be paid? YESNOUNKNOWN Do you have outstanding court fines and/or costs that need to be paid? YESNOUNKNOWN What counties do you have unpaid tickets, fines, or court costs in? (select all that apply) DUVALNASSAUCLAYOTHER FINANCING AMOUNT REQUESTED Is the person whom this financing is for currently incarcerated? YESNO If you answered Yes, what is their expected release date? If you answered Yes, what facility are they in? REFERENCES Please provide the name, address, phone number, and email addresses of at least two (2) individuals for this application REFERENCE #1 REFERENCE #2 AUTHORIZATION I authorize prospective Credit Grantors/Lending/Leasing Companies to obtain personal and credit information about me from my employer and credit bureau, or credit reporting agency, any person who has or may have any financial dealing with me, or from any references I have provided. Any personal and credit information obtained may be disclosed from time to time to other lenders, credit bureaus, or other credit reporting agencies. —Please choose an option—YesNo I hereby agree that the information given is true, accurate, and complete as of the date of this application submission. —Please choose an option—YesNo I give my express consent to process this application and to receive my acceptance or denial via electronic means. —Please choose an option—YesNo Signature of Applicant