MIDWEST ACCEPTANCE CORPORATION REFERENCE SHEET
YOUR NICK NAME (OR ANY OTHER NAME YOU GO BY) ________________________________
YOUR SPOUSE’S NICK NAME (OR ANY OTHER NAME THEY GO BY) _____________________
NAME NAME
ADDRESS ADDRESS
PHONE ( ) PHONE ( )
RELATIONSHIP RELATIONSHIP
NAME NAME
ADDRESS ADDRESS
PHONE ( ) PHONE ( )
RELATIONSHIP RELATIONSHIP
NAME NAME
ADDRESS ADDRESS
PHONE ( ) PHONE ( )
RELATIONSHIP RELATIONSHIP
NAME NAME
ADDRESS ADDRESS
PHONE ( ) PHONE ( )
RELATIONSHIP RELATIONSHIP
IS YOUR PHONE # LISTED ________ UNLISTED ________
WHOSE NAME IS THE PHONE REGISTERED IN?______________________________________
IF THE PHONE IS REGISTERED TO SOMEONE ELSE, WHAT IS THEIR RELATIONSHIP TO YOU?
WHAT IS THE ADDRESS WHERE THIS PHONE RINGS?
CELL/ PAGER # _____________________ CELL/ PAGER # ______________________ DIRECT JOB PHONE #______________________
EMAIL ADDRESS________________________________ EMAIL ADDRESS______________________________________
I AUTHORIZE MIDWEST ACCEPTANCE CORPORATION TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY, OBTAIN CREDIT REPORTS AND RELEASE ALL INFORMATION ABOUT THEIR CREDIT EXPERIENCE WITH ME. I AUTHORIZE THE RELEASE OF ALL EMPLOYMENT AND PAYROLL INFORMATION TO MIDWEST ACCEPTANCE CORPORATION.
______________________________________ _______________________________________
APPLICANT CO-APPLICANT