Sissy's Credit Application

Are you in a Sissys Log Cabin Right Now?*

YesNo

Who is your Current Salesperson

Which Location are you in?

Your Name*

First NameLast Name

Email*

example@example.com

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is mailing address same as physical address?*

YesNo

Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Area CodePhone Number

Cell Phone*

Area CodePhone Number

Living Situation*

OwnRent

What is your mortgage or rent payment?*

DOB*

Date

SSN*

Place of Employment*

Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employer's Phone*

Area CodePhone Number

How long have you been employed?*

Employer Email*

example@example.com

Occupational Title*

Yearly Salary*

Other Income

Name of Previous Employer is current is less than 2 years*

Bank or Credit Union

Account#

Name as shown on Bank Account

Name of Relative Not Living With You

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Second Nearest Relative Not Living With You

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

NOTICE- I understand and authorize that my application will be used to obtain any information from any source required concerning the statements in this application and to verify statements from any source named herein and to generally inquire into my credit record. Also, in connection with my application, an investigation consumer report incuding information as to charachter, general reputation, personal characteristics, and mode of living, whichever are applicable, may be requested by Sissy's Log Cabin.

I agree, in order for you to service my account or to collect any amounts owed to you that you may call me at anyt telephone number associated with my account, including wireless telephone numbers, which could result in a charge to me. You may also communicate with me by sending text messages to my wireless number or emails to my email address. I understand that methods of contact may include using pre-recorded/artificial voice and/or the use of an automated dialing device. These authorizations remain in effect unless I revoke this authorization in writing to you or to any others to which this authorization has been extended. I have read this disclosure and agree that your office or agent may contact me as described above.

I certify that I have read the above agreement in regards to this application, and that all information in this application is true.*

I agreeI DO NOT agree

Signature*

Please take a photo of your drivers license.