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CREDIT INFORMATION

First Name:
Last Name:
Address:
Email:
City:
State:
Zip Code:
Home Phone:	( ) -
Work Phone:	( ) -
Contact Time:
Birth Date:
SSN:	- -

Own/Rent:
Time @ Address:
Employed How Long:
Employer Name:
Address:
City:
State:
Zip Code:
Job Title:
Monthly Income:
Monthly Rent/Mortgage:
Downpayment:
Bankruptcy in past 7 years:	Yes No
Cosigner Available:	Yes No
Checking Account:	Yes No
Savings Account:	Yes No

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