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Please bring this by
our local office
or mail to us at:
ACCEPTANCE LOAN
COMPANY, INC
ATTN: CODY MESSER
1158 WEST FRONT STREET
THOMASVILLE, ALABAMA 36784
PHONE (334) 636-4933
FAX: (334) 636-1684
"For Fast and Courteous
Service - Look to
ALC First"
Two Relatives, Addresses, and Telephone Number
Name_________________________________
Address ______________________________
City _________________________________
Phone _______________________________
Name_________________________________
Address ______________________________
City _________________________________
Phone _______________________________
Name_________________________________
Address ______________________________
City _________________________________
Phone________________________________ |
Name_________________________________ Name________________________________
SS#_________________________________
SS#___________________________________
Address______________________________ City__________________
State___________
Zip Code________________ Years Residence__________ No.
Dependents____________
Home Phone#
_______________________________________________________________
Employer __________________________
Employer_______________________________
Position ___________________________ Position
________________________________
Yrs Emp _______ Gross Income______ Yrs Emp ________Gross Income
____________
Employer Phone# ____________________Employer Phone#
_______________________
Alimony, Child Supports, or separate maintenance income need not be
revealed if you do not wish to have it considered as a basis for
repaying this obligation.
Other
Income_______________________ Other Income____________________________
Do you have a ______________ Checking Account ____________ Savings
Account?
If so, where? ___________________________________________________________
Do you own a ____Home ______Mobile Home _____Rent _____Other?
Monthly Payment ______________ Balance ____________Value _______________
Have you filed bankruptcy? ___________ Yes ___________ No
Auto _________________Yr ___________Mo Payment
___________Balance___________
Auto _________________Yr ___________Mo Payment
___________Balance___________
Other
Creditors:_____________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Dealer: Plaza Golf Cart Sales Phone: 334-289-5891
Fax: 334-2895891
Item
Purchased:_____________________________________________________________
Sales Price _____________Down Payment ______________Amt. /
Fin._______________
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