CONSUMER CREDIT APPLICATION

Required fields marked with *

 

Check Appropriate Box*

We intend to apply for Joint Credit:

SECTION A INFORMATION REGARDING APPLICANT

*

*
*

*

How long there: *


*

*


How long there:

Monthly Earnings *

Permanent Resident Alien?*

Are you a U.S. Citizen? *



How long there:

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Alimony, child support, separate maintenance received under:


Source Other Income (Explain)



*

SECTION B INFORMATION REGARDING JOINT APPLICANT OR OTHER PARTY





How long there:





How long there:

Monthly Earnings

Permanent Resident Alien?

Are you a U.S. Citizen?



How long there:

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Alimony, child support, separate maintenance received under:


Source Other Income (Explain)




 

SECTION C MARITAL STATUS (Do not complete if this is an application for an individual account.)

Applicant:

Other Party:




SECTION D
SECURED CREDIT

Briefly describe the property to be given as security:

List Names and addresses of all co-owners of the property:

If the security is real estate, give the full name of your spouse (if any):

SECTION E

ASSET AND DEBT INFORMATION

If Section B has been completed, this Section should be completed giving information about both the Applicant and Joint Applicant or Other Person. Please mark Applicant related information with an "A." If Section B was not completed, give only information about the Applicant in this Section.

Home



Purchase Price

Down Payment

Rent or Mortgage Payment - Include Taxes & Insurance

Balance Owned 1st Mortgage


Home Improvement Loan or 2nd Mortgage Loan Creditor:

Customers Estimated Value of Property:

2nd Mortgage Payment

Balance Owned 2nd Mortgage

Auto










Auto Physical Damage Insurance Carrier


Checking & Savings Account
Debts

These are stores, banks, savings & loans, finance companies and people with whom you have had credit and shows all your present obligations:

Name of Creditor Address Secured by Interest Rate Account No. Balance Owing Monthly Pmt.


Are you a co-maker, endorser, or guarantor on any loan or contract?


If "Yes" for whom?

To whom?

 

Are there any unsatisfied judgments against you?


Amount?

If "Yes" to whom owned?

 

Have you been declared bankrupt in the last 14 years?


If "Yes" where?

Year

 

Have you ever compromised any debt?

If "Yes" to whom?

 

Other obligations (i.e. liability to pay alimony, child support, separate maintenance)



REQUEST FOR INFORMATION FOR GOVERNMENT MONITORING PURPOSES

To The Applicant(s):

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity, fair housing and home mortgage disclosure laws.  You are not required to furnish this information, but are encouraged to do so.  The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it.  If you furnish the information, please provide both ethnicity and race.  For race, you may check more than one designation.  If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person.  If you do not wish to furnish the information, please check the box below.  (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

Borrower



RACE






SEX





Co-Borrower



RACE






SEX



By clicking "Submit", I hereby authorize the person or firm to whom this application is made, any credit bureau or other investigative agency employed by such person, to investigate the references herein listed or statements or other data from me or from any other person pertaining to my credit and financial responsibility.