CONSUMER CREDIT APPLICATION

Instructions to Married Applicant(s): Answer all questions relating to you. Also answer all questions relating to your spouse unless you are seperated and your spouse is not also applying for credit. All income and property will be assumed to be community property and all obligations will be assumed to be community debts unless "SP" is typed next to the income, property or debt.

Each applicant may apply for individual or joint credit, regardless of marital status. This is application is for:

whose seperate credit application is attached.

APPLICANT
Full Name: # in Family: A value is required.Invalid format.Exceeded maximum number of characters.
U.S. Citizen: Date of Birth: A value is required.Invalid format.
Soc Sec Number: A value is required.Invalid format. Drivers License #:
Marital Status: Home Phone: A value is required.Invalid format.
Current Address: (Street, City, State, & Zip Code)
Current Mailing Address: (If Different)
How Long: Rent/Own $/month: A value is required.Invalid format.
Previous Address: (If at current less than 2 years)
Number of Years: A value is required.Invalid format.Exceeded maximum number of characters.    
 
Employer Name: How Long Employed:
Employers Address:
Occupation: Business Phone: A value is required.Invalid format.
Self-Employed: Gross Monthly Income: A value is required.Invalid format.
 
Previous Employer's Name: How Long Employed:
Previous Employer's Address:
 
Nearest Relative Not Living With You:
Address:
Relationship: Telephone: A value is required.Invalid format.
 
OTHER NET MONTHLY INCOME: You do not have to reveal alimony, child support or separate maintenance income unless you wish to have them considered for approving your application.
Source: Net Income: A value is required.Invalid format.
 
Have you ever had any property reposed?
Do you have any lawsuits pending against you?
Have you ever filed Bankruptcy?
CO-APPLICANT
Full Name: Date of Birth: Invalid format.
Soc Sec Number: Invalid format. Relationship:
Home Phone: Invalid format. Driver's License #:
Current Address:
Number of Yrs: Invalid format.Exceeded maximum number of characters.    
 
Employer Name: Occupation:
Employers Address:
Self-Employed: Business Phone: Invalid format.
How Long Employed: Gross Monthly Income: Invalid format.

Notice for New York Residents - A consumer credit report may be requested in connection with this application or in connection with updates, renewals or extensions of any credit granted as a result of this application. If you subsequently ask for this information, you will be informed whether or not such a report was requested and, if so, the name and address of the agency that furnished the report.

Notice for Ohio Residents - The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Notice to Married Wisconsin Residents - Wisconsin Law provides that no agreement, unilateral statement or court decree relating to marital property shall adversely affect a creditor's interest, unless prior to the time credit is granted the creditor is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision. You must indicate the name of your spouse on the installment contract, and the address if different from yours.

Notice to California and Utah Residents - As required by law, you are hereby notified that a negative credit report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations.

Notice for Maine Residents - If this application is approved by the creditor, you will be required to obtain and maintain physical damage insurance on the collateral securing the debt. You have a right of free choice in the selection of the agent and insurer through or by which the insurance is placed.

I hereby affirm that the foregoing Information is true and correct and made for the purpose of obtaining credit. I authorize you to obtain additional information from any source(s) and each such source is hereby authorized to provide you with such information. I also grant you permission to obtain a credit report on me for all legitimate purposes in connection with this transaction. Such purposes included assisting in making a credit decision, reviewing my account, and assisting in taking collection activity. I also authorize you to share all the foregoing information with lending institutions and their subsidiaries as necessary to assist in making a credit determination. This application, in any event, shall be and remains the property of the Lender, and is subject to the completion and acceptance of additional credit application documents prior to any approved extension of credit.

I have read and understand the terms associated with this application: Please make a selection.

Applicant:

Date: A value is required.Invalid format.

Co-Applicant:

Date: Invalid format.