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CREDIT APPLICATION

 
 

Name: __________________________________________________________________

 
Date: ___________________________________________________________________

 
Present Address:   _________________________________________________________                  

 No. Years: _______________________________________________________________

Own or Rent: _____________________________________________________________

No. of Dependents: ________________________________________________________

Name and address of employer: ______________________________________________

 
Years employed in this type of work or profession: ________________________________

 Years on this job: __________________________________________________________

 Position/Title: _____________________________________________________________

 Type of business: _________________________________________________________

 Home phone: _____________________________________________________________

 Business phone: ___________________________________________________________

 Gross monthly income: _____________________________________________________

 Base employment income: ___________________________________________________

 Overtime: _________________________________________________________________

 Bonuses: _________________________________________________________________

 Commissions: _____________________________________________________________

 Dividends/Interest: __________________________________________________________

 Net Rental Income: __________________________________________________________

 Other Sources: _____________________________________________________________

 
 (Alimony, child support or separate maintenance income need not

 be revealed if the Borrower does not choose to have it considered

 as a basis for repaying this loan.)

 If employed in present position less than two years

state: _____________________________________________________________________

 Previous employer: __________________________________________________________

 Type of business: ____________________________________________________________

 Position: ___________________________________________________________________

 Dates from/to: _______________________________________________________________

 Monthly income: _____________________________________________________________

 Have you declared or been declared bankruptcy in the past

 five years?: _________________________________________________________________

 Are you a party to any lawsuit?: _________________________________________________

  ASSETS: ___________________________________________________________________

 DEBTS: ____________________________________________________________________

 
Checking and Savings Accounts: ________________________________________________

 Loans: _____________________________________________________________________

 Stocks and Bonds: ___________________________________________________________

 Notes: _____________________________________________________________________

 Credit Cards: ________________________________________________________________

 Real Estate Owned: __________________________________________________________

 Retirement Fund: ____________________________________________________________

 Net Worth of Business Owned: __________________________________________________

 Automobile (make and year): ____________________________________________________

 Other: _______________________________________________________________________

  

___________________________________

Borrower