Line of Credit Application
________________[Instruction: Insert name of credit company/letterhead here.]
Applicant Personal Information
Applicant Name _________________
Applicant Address __________ Applicant City, State, Zip Code ______________
Daytime Phone Number (___) __________ Social Security Number ___________________
Birth Date (dd/mm/yyyy) ________________________
Co-Applicant Name _________________ (if any)
Co-Applicant Address ________________ Co-Applicant City, State, Zip Code ______________
Daytime Phone Number (___) ___________ Social Security Number ___________________
Birth Date (dd/mm/yyyy) ________________________
Applicant Employment Information
Name of Employer _____________________
Employer Address __________ Employer City, State, Zip Code ________________
Supervisor’s Name __________________ Applicant’s Title ____________________________
Length of Employment __________ Gross Income ______________________
Bank Reference Information
Bank Name _________________________
Bank Address __________________________ Bank City, State, Zip Code _________________
Account Number _________________ Approximate Available Balance ___________________
Credit Account Reference (may include major credit card, loan, revolving credit account)
Creditor Name __________________________
Creditor Address ____________________ Creditor City, State, Zip Code _______________
Account Number _______________ Approximate Balance __________________
Personal Reference
Name ___________________ Contact Information ________________________
Name ___________________ Contact Information ________________________
By signing below, Applicant hereby authorizes Creditor to obtain such information as required to
confirm the statements provided above, and agrees that this application shall remain Creditor’s
sole property. Applicant agrees the above is presented for approval only, and final acceptance or
rejection shall be in Creditor’s sole discretion. Applicant shall have only those rights and
remedies permitted at law or in equity, but shall have no other claim against Creditor for any
credit decision. A rejection by Creditor shall relieve Creditor of any potential obligation to
Applicant.
______________________________ _________________
Applicant Date
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