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Credit Application
CREDIT APPLICATION
Name: Date:
Present Address: No. Years:
Own or Rent:
No. of Dependents:
Name and address of employer:
Years employed in this type of work or profession:
Years on this job:
Position/Title:
Type of business:
Home phone:
Business phone:
Gross monthly income:
Base employment income:
Overtime:
Bonuses:
Commissions:
Dividends/Interest:
Net Rental Income:
Other Sources:
(Alimony, child support or separate maintenance income need not
be revealed if the Borrower does not choose to have it considered
as a basis for repaying this loan.)
If employed in present position less than two years
state:
Previous employer:
Type of business:
Position:
Dates from/to:
Monthly income:
Have you declared or been declared bankruptcy in the past
five years?:
Are you a party to any lawsuit?:
ASSETS DEBTS
Checking and Savings Accounts Loans
Stocks and Bonds Notes
Credit Cards
Real Estate Owned
Retirement Fund
Net Worth of Business Owned
Automobile (make and year)
Other
___________________________________
Borrower
Form 122
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