Application First Name Last Name SSN Date of birth Address & City Georgia Email Zip_Code Phone How long at job Employer Phone Number with extension Address How often are you paid How much do you bring home after tax, on your paycheck? Where did you work before your current position? How long were you on this job? Please list 2 years of job history with employer name and length of the time employed. Please Allow us to ask you how much are you looking to Borrow? PLEASE READ THIS BEFORE YOU CLICK SUBMIT!! When you fill out this application, you agree to My Coastal Finance pulling your credit so that they can decide whether you qualify for a loan. Thanks for your permission 5 + 1 = Submit