*I have an active check account Yes No
*My credit score falls between
501 – 629
630 - 700
*How long have the lived at your current address?
Have you lived in the same state for 5 years? Yes No
*Is your net monthly income after taxes > $2,000?
*How did you hear about our company?
Internet Search (Google, Yahoo, MSN, Etc)
Drove by Branch/Saw Sign
*Your email address