CREDIT APPLICATION Name: ___________________________ Date: ________________________
Date of Birth: _____________________ Present Address: _________________________________ _________________________________
SSN: ________________________ Phone: _______________________
Years At Address: _____
Own or Rent: ________ Monthly Payment: _________
No. of Dependents: _______
Name and Address of Employer: _____________________________________ _____________________________________ Years Employed: ______________
Phone: _______________________
Position/Title: _________________
Gross Monthly Income: __________
Gross Additional Income: ________
Other sources of income (Specify type and amount): ___________________________. (Any additional income need not be revealed if the Borrower does not choose to have it considered as a basis for repaying this loan.)
If employed less than 2 years at present job, give Name and Address of Previous Employer: _____________________________________ _____________________________________ Phone: _______________________ Salary: ___________________ Length of Employment: _________
Have you declared bankruptcy in the past five years?: _____________ Are you a party to any lawsuit?: ______________
ASSETS
Checking and Savings Accounts: ____________________________
Stocks And Bonds: _____________________________
Real Estate Owned: ____________________________
Automobile Owned: _____________________________
Retirement Fund: ____________________________ Other Assets:
Net Worth of Business Owned _____________________________
_____________________________________________________________________
LIABILITIES
Credit cards: ____________________________
Notes: _____________________________
Loans: ____________________________
Other: _____________________________
____________________________ Borrower
_____________________________ Date