Furniture Mi Casa Finance Application
Please Fill out All Required Fields
Social Security or ITN
Rent or Mortgage Amount
Date of Birth
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DD
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YYYY
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FINANCE NOW!
Name *
First and last name
Address
Email *
Phone number *
Employer Name
Employer Address
Employer Phone Number
Date of Hire
MM
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DD
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YYYY
Monthly Net Income
Frequency of Pay
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Bank Name
Checking Routing Number
Checking Account Number
Has this account been open at least 90 days?
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Personal Reference (Name, Address, Phone)
Disclosure
By signing below I hereby (a) certify that all information I have provided on this application or in connection herewith is true, correct and complete; (b) understand and agree that FurnitureMiCasa, ACIMA, Westcreek, Kornerstone may contact any person or company listed herewith for information about me and I fully release all parties from all liability for any claims that may result; (c) understand that this application is subject to approval by FurnitureMiCasa ACIMA, Westcreek, Kornerstone and its offices and that payments are remitted to them;(d) understand and agree that FurnitureMiCasa, ACIMA, Westcreek, Kornerstone, may obtain a consumer report in connection with my application, and any updates, renewals or extensions of my transaction as a result of my application or other transactions hereto related; (e) understand that if I ask, I will be informed whether or not such a report was obtained and, if so, the name and address of the agency that furnished the report.
Signature
Date
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