Application For A Loan

Tell Us About Yourself Tell Us About Yourself -

Full Name (First, Middle, Last)

Email Address

SSN

Full Address

Cell Phone #

Time at Address

Additional Phone #

Date of Birth

Rent or Own? Rent or Own? Rent Own Live w/Parents Other

If Other, Please Specify

Marital Status Marital Status Single Married Divorced

Number Of Children

Monthly Income Monthly Income -

Employer/Source of Income

Employer Telephone #

Date of Hire

Monthly Income

Additional Income

Monthly Expenses Monthly Expenses -

Rent/Mortgage

Cable/Internet

Car Payment

Cell Phone

Car Insurance

Credit Cards/Loans

Utilities

Food

References - Please List 4 (Parents, Relatives, Friends not living with you) References - Please List 4 (Parents, Relatives, Friends not living with you) -

Reference #1 Name

Relationship

Cell Phone #

Reference #2 Name

Relationship

Cell Phone #

Reference #3 Name

Relationship

Cell Phone #

Reference #4 Name

Relationship

Cell Phone #

Collateral/Security Items (All loans will be Secured = Must have Collateral) Collateral/Security Items (All loans will be Secured = Must have Collateral) -

Item #1 - Example: Car Title, TV, DVD Player, Stereo, Jewelry, Computer, Tools, Equipments, Firearms etc.

Item #2 - Example: Car Title, TV, DVD Player, Stereo, Jewelry, Computer, Tools, Equipments, Firearms etc.

Amount Financing (between $100.00 - $1,760.00) Amount Financing (between $100.00 - $1,760.00) -

I would like to apply for the following amount:

Reason for Loan Application

How did you hear about us? How did you hear about us? Cliff's Customer Website Flier Store Sign Employee Referral Google

If an employee of Cliff's referred you, who was the employee?

Release of Information Release of Information -

Release of Information - I promise that the information I have provided on this form is correct. I authorize verification of all information on this application for the purpose of obtaining this cash advance and all renewals or extensions thereof. Everything I have stated in this application is correct to the best of my knowledge. Cliff's Finance Co. is authorized to check my credit and employment history and provide credit reference to any company I authorize.

Please Type Your Name Here After Reading The Statement Above

Date:

Email: