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EASTSIDE

CREDIT CORP.

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Loan Application

First Name

Last Name

Email

Phone

Street Address

City

State

Zip Code

At this address since

Do you rent or own?

Rent

Own

Other

How much do you pay for housing?

Applicant's social security number

Date of Birth

Employer

Job Position or Title

Employer's Phone Number

Hired Date

Monthly Take Home Pay

Pay Period

Any Other Income

Source of Other Income

Have you ever filed for bankruptcy?

Yes

No

Desired Loan Amount

What will this loan be used for?

Will you be applying for this loan with a co-applicant?

Yes

No

Co-Applicant's First Name

Co-Applicant's Last Name

Co-Applicant's Email

Co-Applicant's Phone

Co-Applicant's Street Address

City

State

Zip Code

Co- applicant at this address since

Do you rent or own?

Rent

Own

How much do you pay per month?

Co-Applicant's Social Security Number

Co-Applicant Date of Birth

Co-Applicant's Employer

Co-Applicant's Job Position or Title

Co-Applicant's Employer's Phone Number

Co-Applicant Hired Date

Monthly Take Home Pay

Pay Period

Any Other Income

Source of Other Income

Have you ever filed for bankruptcy?

Yes

No

Thanks for submitting. A representative will be contact you during working hours.

Contact

Phone: 985-655-5626
Fax: 985-655-5627

756 Grand Caillou Rd.

Houma, LA 70363

Hours

Monday - Thursday - 8:30 a.m. - 5 p.m.

Friday - 8:30 a.m. - 5:30 p.m.

Saturday - By appointment only

Sunday - Closed

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