Furniture Mi Casa Finance Application
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Social Security or ITN
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Rent or Mortgage Amount
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Date of Birth
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FINANCE NOW!
Name *
First and last name
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Address
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Email *
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Phone number *
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Employer Name
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Employer Address
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Employer Phone Number
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Date of Hire
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Monthly Net Income
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Frequency of Pay
Bank Name
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Checking Routing Number
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Checking Account Number
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Has this account been open at least 90 days?
Personal Reference (Name, Address, Phone)
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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
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Date
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