Please answer all questions that apply. Incomplete
applications will not be approved.
Only required if you want us to consider spouses income for
(Must List All Five)
How did you hear about us?
Yellow Pages Ad
Have you ever cashed checks with anyone else?
If Yes Where?
How far do you live from our store? (Miles)
Less than 1
2 to 3
3 to 5
Read Statement Before Sending:
I certify the information supplied by me on this form
is true and correct. I authorize verification of the truthfulness of all
information contained herein, including contact with any person, or firm
listed above, and fully release all parties from all liability for any
damage that may result. Any false statement made above shall be sufficient
basis for rejection. By clicking submit application acknowledges that I
have read and understand the above statement.