LC Inquiry 1.0

1
What is your name?
2
Need more cash? Tell us how much.* This field is required.
3
Select the company that sent your check.* This field is required.
Citizens Finance of Fort Payne, Inc.
Citizens Finance of Guntersville, Inc.
Citizens Finance of Huntsville, Inc.
Community Credit of Leeds, Inc.
Citizens Finance, Inc. (Oneonta)
Citizens Finance of Oxford, Inc.
Community Credit, Inc. (Pell City)
Citizens Finance of Sylacauga, Inc.
Citizens Finance of Tuscaloosa, Inc.
4
5
Confirm the number on the check.* This field is required.
6
Have you cashed the check yet?* This field is required.
YESNO
7
Employment Information* This field is required.
Place of Employment
Monthly net income
8
Contact Information* This field is required.
Email address
Cell phone
9
Officer
10
CompanyStreet
11
CompanyCity
12
CompanyState
13
CompanyZip
14
CompanyTel
15
When you press submit, this inquiry will be sent to {selectThe} (the "Company"), which is located at {companystreet}, {companycity}, {companystate} {companyzip} and you are authorizing the Company to contact you concerning this request. This submission is not an application for credit. You can also reach the Company at {companytel}. Thank you!
Should be Empty: