Fields marked with a * are required.

Applicant Information

Address / Contact Info

Applicant Expense Information

If Yes

If Yes


I hereby authorize Simon Electronics to acquire any information necessary on my behalf to facilitate my application for credit.


I have provided true and accurate information required by Simon Electronics and by applying for credit to establish an account with Simon Electronics I authorize and agree to the following processes: 

Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and may be asked to provide supporting documentation to support this requirement. The information you provided is protected by federal law and our privacy policies. I have provided correct and accurate personal information to Simon Electronics and authorize Simon Electronics to obtain, verify, record and keep secure such information for the purposes of verification of my identity. I understand that by submitting this application I am authorizing Simon Electronics to request a credit report on me and anyone cosigning on this loan with me. 

I understand that this is done in considering this application for the purpose of an update, renewal, or extension of credit. At my request, Simon Electronics will provide the name and address of any and all credit reporting agencies from which a report was obtained. 

Simon Electronics may contact me about my established account or any information provided about my application or established account at any time, now or in the future, until such account is paid in full.