Chelmont Finance
Application step 1 Online Form
Amount Desired

Reason for Loan
Married
Unmarried
First Name

Middle Name

Last Name

Address

How Long

City

State

Zip

Home Phone

Cell Phone

Work Phone

Contact No.

E-mail :

Employment

Address

Position

How Long
Working






Salary
Amount







Supervisor's
Name

Supervisor's
Phone No.

Other
Income
Amount

Source of
Income
Years & Months
(915) XXX-XXXX

(915) XXX-XXXX

(915) XXX-XXXX

(915) XXX-XXXX
Phone number where you can be reached
Full Time
Part Time
Seasonal
Other
Weekly
Biweekly
Monthly
Bimonthly
Other
I wish to include the information about my spouse
I do not wish to include the information about my spouse
Everything that I have stated in this application step 1 is correct to the best of my knowledge. I
understand that you will contact me by telephone for further information. You are authorized to
check my credit, employment history and to answer questions about your credit experience with me
I agree to terms and conditions
Chelmont Finance Co.
4911 Montana Ave
El Paso, TX 79903

Phone: (915) 562-2662
Fax:      (915) 562-9520
M-F : 9:00 am - 6:00 pm
Sat : 9:00 am - 5:00 pm
Apply OnLine Secure Site