FULL NAME   DATE  

ADDRESS     HOW LONG YR

CITY, ST., ZIP

LESS  5YR     HOW LONG YR

PHONE           CELL UNMARRIED

BIRTHDAY      SSI # MARRIED

DRIVERS LICENSE #  BANK     

WORK            PHONE  

INCOME            Per WEEK MONTH

ADDRESS    HOW LONG YR

CITY, ST. ZIP

PREVIOUS WORK HOW LONG    YR

ANY OTHER INCOME

BANKRUPTCY IN THE LAST 3YRS     REPOSSESSION    

Click here if you live, work, or go to school in Clackamas county?

PERSONAL REF . PHONE

BUYING ITEM        DOWN PAY 

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