CREDIT APPLICATION
Name: ___________________________ Date: ________________________
Date of Birth: _____________________ SSN: ________________________
Present Address: Phone: _______________________
_________________________________
_________________________________
Years At Address:
_____ Own or Rent: ________
Monthly Payment: _________
No. of Dependents:
_______
Name and Address of
Employer: Phone: _______________________
_____________________________________
_____________________________________
Years Employed: ______________ 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: Net
Worth of Business Owned
____________________________ _____________________________
Other Assets:
_____________________________________________________________________
LIABILITIES
Credit cards: Notes:
____________________________ _____________________________
Loans: Other:
____________________________ _____________________________
____________________________ _____________________________
Borrower Date
