CREDIT APPLICATION

APPLICANT: LAST NAME FIRST NAME MIDDLE NAME BIRTHDATE SOCIAL SECURITY NO ADDRESS (WHERE YOU LIVE) CITY STATE ZIP CODE HOW LONG AT THIS ADDRESS? HOME PHONE NO CELL PHONE NO OTHER PHONE NO MARITAL STATUS MARRIED UNMARRIED SEPERATED DRIVER LICENSE NO LICENSE STATE HIGHEST LEVEL OF EDUCATION (NAME OF HIGHSCHOOL OR COLLEGE) CITY/STATE MAJOR/DEGREE YEARS ATTENDED GRADUATION DATE RESIDENCE IN THE NAME OF RELATION RESIDENCE PHONE NO RENT (YOURS) PROPERTY MANAGER/OWNER NAME OWNER PHONE NO MORTGAGE/RENT TOTAL PREVIOUS ADDRESS PREVIOUS CITY PREVIOUS STATE PREVIOUS ZIP CODE HOW LONG AT PREVIOUS ADDRESS EMPLOYER NAME EMPLOYMENT STATUS SELF EMPLOYED OCCUPATION/TITLE HOW LONG EMPLOYED EMPLOYER ADDRESS EMPLOYER CITY EMPLOYER STATE EMPLOYER ZIP CODE EMPLOYER PHONE NUMBER ADDRESS (WHERE YOU WORK) WORK CITY WORK STATE WORK ZIP CODE WORK PHONE NUMBER PAY RATE PAY RATE (CHOOSE ONE) HOURLY SALARY COMM CHECK ONE FULL TIME PART TIME NUMBER OF HOURS PER WEEK INCOME TYPE (CHOOSE ONE) CASH INDEP. CONTRACTOR WZ BANK NAME ACCOUNT NUMBER BANK PHONE NO	CO-APPLICANT: LAST NAME FIRST NAME MIDDLE NAME BIRTHDATE SOCIAL SECURITY NO ADDRESS (WHERE YOU LIVE) CITY STATE ZIP CODE HOW LONG AT THIS ADDRESS? HOME PHONE NO CELL PHONE NO OTHER PHONE NO MARITAL STATUS MARRIED UNMARRIED SEPERATED DRIVER LICENSE NO LICENSE STATE HIGHEST LEVEL OF EDUCATION (NAME OF HIGHSCHOOL OR COLLEGE) CITY/STATE MAJOR/DEGREE YEARS ATTENDED GRADUATION DATE RESIDENCE IN THE NAME OF RELATION RESIDENCE PHONE NO RENT (YOURS) PROPERTY MANAGER/OWNER NAME OWNER PHONE NO MORTGAGE/RENT TOTAL PREVIOUS ADDRESS PREVIOUS CITY PREVIOUS STATE PREVIOUS ZIP CODE HOW LONG AT PREVIOUS ADDRESS EMPLOYER NAME EMPLOYMENT STATUS SELF EMPLOYED OCCUPATION/TITLE HOW LONG EMPLOYED EMPLOYER ADDRESS EMPLOYER CITY EMPLOYER STATE EMPLOYER ZIP CODE EMPLOYER PHONE NUMBER ADDRESS (WHERE YOU WORK) WORK CITY WORK STATE WORK ZIP CODE WORK PHONE NUMBER PAY RATE PAY RATE (CHOOSE ONE) HOURLY SALARY COMM CHECK ONE FULL TIME PART TIME NUMBER OF HOURS PER WEEK INCOME TYPE (CHOOSE ONE) CASH INDEP. CONTRACTOR WZ BANK NAME ACCOUNT NUMBER BANK PHONE NO
Comment: 1, undersigned (1) make the above representations, which are certified correct for the purpose of securing credit; (2) authorize financial institutions to obtain consumer credit reports on me periodically and to gather employment history as they consider necessary and appropriate; (3) authorize your affiliates to obtain consumer credit reports on me; (4) Unless the circle that follows is marked, i authorize the dealer and any assignee or other person to whom this application is submitted to share and use information about marked, i direct the dealer and any assignee of other person to whom this application is submitted not to give information to such entities (other than information on their own transactions and experiences). ; (5) Understand that we or any financial institution to whom it is submitted, will retain this application wheter or not it is approved and that it is the applicant's responsibility to notify the creditor of any change of name, address or employment.
APPLICANT SIGN WITH NAME: DATE:	APPLICANT SIGN WITH NAME DATE:
REFERENCES Minimum of five references from seperate households, including minimum of 3 immediate family references from seperate household (parent, sibling, aunt/uncle or cousin). NO EXCEPTIONS!
IMMEDIATE FAMILY MEMBER 1: NAME ADDRESS CITY STATE ZIP CODE TELEPHONE CELL/PAGER RELATION	IMMEDIATE FAMILY MEMBER 2: NAME ADDRESS CITY STATE ZIP CODE TELEPHONE CELL/PAGER RELATION
IMMEDIATE FAMILY MEMBER 3: NAME ADDRESS CITY STATE ZIP CODE TELEPHONE CELL/PAGER RELATION	REFERENCE 4: NAME ADDRESS CITY STATE ZIP CODE TELEPHONE CELL/PAGER RELATION
REFERENCE 5 NAME ADDRESS CITY STATE ZIP CODE TELEPHONE CELL/PAGER RELATION	REFERENCE 5: NAME ADDRESS CITY STATE ZIP CODE TELEPHONE CELL/PAGER RELATION

I, , hereby declare under penalty of perjury that the above is complete and true and correct to the best of my knowledge.