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SIMI VALLEY PHOTO LABS |
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| Credit Application |
Please complete and fax to: 805-577-9188 |
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Name ___________________________________________ Date of Birth ___________________ First Name of Spouse __________________________ Social Security Number_______________ Home Address __________________________ City ______________State ____ Zip __________ Home Phone ( ) _______________Years at Present Address ______ Own Home ___ Rent ___ Married ____ Single ____ Divorced ____ Widow(er)____ Number of Dependents __________ Previous Home Address ___________________________________ How Long ______________ Firm Name or Employer's Name _____________________________Years There _____________ Address ______________________________City _________________ State _____ Zip _______ Business Phone ( ) _______________ Position ____________ Nature of Business _________ Previous Employer ______________________________________________ Years There ______ Address ______________________________ City _________________State ______ Zip ______ Your Present Annual Salary __________________ list Source_____________________________ Personal References: Name _______________________________________________________ Address_______________________________ City________________ State _____ Zip _______ Credit References: Name ________________ Acct# ________________ Open ____ Close ____ Address______________________________ City_______________ State ______ Zip ________ Name ______________________________ Acct# _________________ Open _____ Close ____ Address____________________________ City_________________ State ______ Zip ________ Bank ______________________________ Branch ______________________________________ Type of Account __________________ Account # _____________________________________ Bank ______________________________ Branch ______________________________________ Type of Account ____________________ Account # ____________________________________ Nearest Relative or Friend Not Living with you __________________________________________ Address____________________________City__________________ State ______ Zip ________ I hereby certify that the information in
this credit application is correct. I hereby authorize you _______________________________________________
Date _____________________ |
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