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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?	Invalid Input
How did you hear about Fitzpatrick's Furniture? (*)	Please SelectRadioTVReferralSearch EngineFacebookPinterestPrevious CustomerOther Please tell us how big is your company.
First Name (*)	Please type your first name.
Last Name (*)	Invalid Input
Home Phone: (*)	Invalid Input
Date of Birth: (*)	Invalid Input
SS#: (*)	Invalid Input
E-mail (*)	Invalid email address.
Marital Status:	MarriedUnmarriedSeparated Invalid Input
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Street Address 2	Invalid Input
City, State, Zip Code (*)	Invalid Input
Time at Residence:	Invalid Input
Residential Status	RentingBuying/OwnOther Invalid Input
If Other Please Explain	Invalid Input
Monthly (Rent/Mortgage) Payment: (*)	Invalid Input
Landlord/ Mortgage Co. / Name on Lease	Invalid Input
Phone Number:	Invalid Input
Employer's Name:	Invalid Input
Employer's Phone Number:	Invalid Input
Job Title:	Invalid Input
Time on Job:	Invalid Input
Work Address	Invalid Input
Income: Take Home Pay Per Check	Invalid Input
Are you paid	WeeklyBi-WeeklyBi-MonthlyMonthly Invalid Input
Additional Income: (Please Explain)	Invalid Input
Bank Name:	Invalid Input
Checking and/or Savings	CheckingSavingsBoth Invalid Input
Debit Card/Pay Card/Direct Express:	YesNo Invalid Input
How Long:	Invalid Input
Good Standing:	YesNo Invalid Input
Do you have direct Deposit? (*)	YesNo Invalid Input
Any Rent to Own Accounts?	YesNo Invalid Input
If yes with whom	Invalid Input
What are you renting	Invalid Input
Payment on rental	Invalid Input
Are you currently in or planning on filling Bankruptcy within the next 6 months	YesNo Invalid Input
	Co-Applicant Information
Full Name	Please type your full name.
Home Phone:	Invalid Input
Date of Birth:	Invalid Input
SS#:	Invalid Input
E-mail	Invalid email address.
Marital Status:	MarriedSingleDivorcedWidowed Invalid Input
Street Address:	Invalid Input
City, State, Zip Code	Invalid Input
Time at Residence:	Invalid Input
Employers Name:	Invalid Input
Employers Phone Number:	Invalid Input
Job Title:	Invalid Input
Time on Job:	Invalid Input
Work Address	Invalid Input
Income: Take Home Pay	Invalid Input
Are you paid	WeeklyBi-WeeklyBi-MonthlyMonthly Invalid Input
Additional Income: (Please Explain)	Invalid Input
Spam Control (*)	Invalid Input
	All credit applications will be processed by pulling a credit check.