Credit Application

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Credit Application
Please fill in the fields below and click submit. Fitzpatrick's Furniture will follow up on your application.
What are we shopping for today?
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How did you hear about Fitzpatrick's Furniture? (*)
Please tell us how big is your company.
First Name (*)
Please type your first name.
Last Name (*)
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Home Phone: (*)
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Date of Birth: (*)
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SS#: (*)
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E-mail (*)
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Marital Status:
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Street Address: (*)
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Street Address 2
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City, State, Zip Code (*)
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Time at Residence:
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Residential Status
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If Other Please Explain
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Monthly (Rent/Mortgage) Payment: (*)
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Landlord/ Mortgage Co. / Name on Lease
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Phone Number:
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Employer's Name:
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Employer's Phone Number:
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Job Title:
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Time on Job:
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Work Address
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Income: Take Home Pay Per Check
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Are you paid
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Additional Income: (Please Explain)
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Bank Name:
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Checking and/or Savings
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Debit Card/Pay Card/Direct Express:
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How Long:
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Good Standing:
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Do you have direct Deposit? (*)
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Any Rent to Own Accounts?
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If yes with whom
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What are you renting
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Payment on rental
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Are you currently in or planning on filling Bankruptcy within the next 6 months
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Co-Applicant Information

Full Name
Please type your full name.
Home Phone:
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Date of Birth:
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SS#:
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E-mail
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Marital Status:
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Street Address:
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City, State, Zip Code
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Time at Residence:
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Employers Name:
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Employers Phone Number:
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Job Title:
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Time on Job:
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Work Address
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Income: Take Home Pay
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Are you paid
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Additional Income: (Please Explain)
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Spam Control (*) Spam Control
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All credit applications will be processed by pulling a credit check.