Customer Application and Information Request Form

If you are applying for credit through this electronic process, you should be aware of the following information and must affirmatively agree to the following:

 

1.             If you proceed, you are agreeing to complete the application process electronically. 

2.             Your responses to all questions throughout either electronic process will be recorded and made part of your electronically signed documents.

3.             You have the option to complete this process using the traditional paper and ink signature process. You must contact Whitestone Financial at 336-712-9612 if you wish to sign your application in ink.

4.             Your electronic signature will consist of your typed name and email address which will be unique to you.

By typing your name below and clicking on “Submit” below, you acknowledge and agree to all of the following:

 

•              I have read and understood the foregoing;

•              I agree to proceed with the credit application through electronic means;

•              I agree that my electronic signature is the equivalent of a manual signature and that Whitestone Financial may rely on it as such;

•              I acknowledge and agree that the individual completing this Consent to Proceed Electronically is the individual whose name the application is being requested and whose name is typed below.

•             I acknowledge that Whitestone believes this information to travel to us securely. However, we take no responsibility for your information from the time you submit it until the time it reaches us electronically. 

•             I acknowledge that Whitestone may retrieve a consumer credit report and I grant them permission to do so based on my information and electronic signature. 

 

Primary Applicant

Name:

Address:                     Date of Birth:

City/State/Zip  Social Security#                                 

Phone:Mobile Ph:

Landlord or Mortgage     Payment:

Employment:   Length of Employment:

Employment Ph:

Previous Employment:                      Length of Employment:

Other Income:    How Much:

Electronic Signature Portion

Type your Full Name:     

Type you Email address:


Secondary Applicant

Name:

Address:                     Date of Birth:

City/State/Zip  Social Security#                                 

Phone:Mobile Ph:

Landlord or Mortgage     Payment:

Employment:   Length of Employment:

Employment Ph:

Previous Employment:                      Length of Employment:

Other Income:    How Much:

Electronic Signature Portion

Type your Full Name:     

Type you Email address:

 


Other

Vehicle you may trade:

How much can you pay down?

Have you ever filed bankruptcy?No      Yes       Date:

If you have a vehicle financed now list finance source:

Type of Vehicle you would like us to help locate:

Your email address:

How would you liked to be contacted?

 

 


Whitestone Financial Inc.
Copyright © 2014 [Whitestone Financial Inc]. All rights reserved.
Revised: December 23, 2013