Fill and Sign the Application for Open End Unsecured Credit Signature Loan Form

Application for Open End Unsecured Credit IMPORTANT: Read these Directions before completing this Application. Check Appropriate Box If you are applying for an individual account in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A and D. If you are applying for a joint account or an account that you and another person will use, complete all sections, providing information in Section B about the joint applicant or user. If you are applying for an individual account, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all sections to the extent possible, providing information in Section B about the person on whose alimony, support, or maintenance payments or income or assets you are relying. SECTION A. INFORMATION REGARDING APPLICANT Full Name (Last, First, Middle): ________________________________________________________ Birth Date: ____________________ Present Street Address: _______________________________________________________________ Years at that address: _______ City: _________________________ State: ________________________ Zip: _______________ Telephone No. of Applicant: _________________________ Social Security No.: ________________________________ Driver's License No.: _______________________________ Previous Street Address: ______________________________________________________________ Years at that address: ________________ City: ________________________ State: _________________________ Zip: _______________ Name of Present Employer: ____________________________________________________ Years there: ____________ Telephone No. of Employer: ____________________________________ Position or title with Employer: __________________________________ Name of Supervisor: ___________________________________________ Employer's Address: ___________________________________________ Previous Employer: ____________________________________________ Years there: _________ Address of Previous Employer: _____________________________________________________ Present net salary or commission: $________ per month week Number of Dependents: ______ Age of each: _____ _____ _____ _____ Note: 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: Court order Written agreement Oral understanding Other income: $____________ per month week Source(s) of other income: ___________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Is any income listed in this section likely to be reduced in the next two years? Yes (Explain in detail on a separate sheet.) No Have you ever received credit from us? No Yes When? _____________________ Office where received: ___________________________________________________________ Checking Account No.: _________________________________________ Institution and Branch: ___________________________________________________________ ________________________________________________________________________________ Savings Account No.: _________________________________________ Institution and Branch: ______________________________________________________________ _________________________________________________________________________________ Name of nearest relative not living with you: _____________________________________________ Address of relative: _________________________________________________________________ Telephone No. of relative: __________________________________________ SECTION B. INFORMATION REGARDING JOINT APPLICANT, USER, OR OTHER PARTY (Use separate sheets if necessary.) Full Name (Last, First, Middle): ________________________________________________ Birth Date: ____________________ Present Street Address: ________________________________________________________________ Years at that address: _______ City: ___________________________ State: __________________________ Zip: _______________ Telephone No. of Applicant: ________________________________ Social Security No.: _______________________________________ Driver's License No.: ______________________________________ Previous Street Address: _______________________________________________________________ Years at that address: _______ City: ___________________________ State: ___________________________ Zip: _______________ Name of Present Employer: ____________________________________________________ Years there: ____________ Telephone No. of Employer: ___________________________________ Position or title with Employer: ________________________________________________________ Name of Supervisor: _____________________________________________________ Employer's Address: _______________________________________________________________ Previous Employer: _______________________________________________________ Years there: _________ Address of Previous Employer: _______________________________________________________ Present net salary or commission: $________ per month week Number of Dependents: ______ Age of each: _____ _____ _____ _____ Note: 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: Court order Written agreement Oral understanding Other income: $____________ per month week Source(s) of other income: ____________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________________________ Is any income listed in this section likely to be reduced in the next two years? Yes (Explain in detail on a separate sheet.) No Have you ever received credit from us? No Yes When? _______________________ Office where received: ________________________________________________________________ Checking Account No.: _________________________________________ Institution and Branch: ________________________________________________________________ ____________________________________________________________________________________ Savings Account No.: _________________________________________ Institution and Branch: _______________________________________________________________ __________________________________________________________________________________ Name of nearest relative not living with you: ___________________________________________ Address of relative: ___________________________________________________________________ Telephone No. of relative: __________________________________________ SECTION C. MARITAL STATUS (Do not complete if this is an application for an individual account.) Applicant: Married Separated Unmarried (including single, divorced, and widowed) Other Party: Married Separated Unmarried (including single, divorced, and widowed) SECTION D. ASSET AND DEBT INFORMATION (If Section B has been completed, this section should be completed giving information about both the Applicant and Joint Applicant, User, or Other Person. Please mark Applicant-related information with an "A." If Section B was not completed, only give information about the Applicant in this section.) Description of Assets Value Subject to Debt? Owner(s) Yes/No Cash $__________ ___________ _________________ Automobile (Make, Model, Year) ___________________________ $__________ ___________ _________________ ___________________________ $__________ ___________ _________________ Cash Value of Life Insurance Issuer_____________________ Face Value $_____________ _____ _________________ Issuer_____________________ Face Value $_____________ _____ _________________ A. Real Estate  Location: _______________________________________________________________  Date Acquired: ____________  Fair Market Value $____________  Subject to Debt Yes No If so, amount $ _______________  Owners _________________________________________________________________ B. Real Estate  Location: _______________________________________________________________  Date Acquired: ____________  Fair Market Value $____________  Subject to Debt Yes No If so, amount $ _______________  Owners _________________________________________________________________ A. Marketable Securities  Issuer _____________________________________  Type _______________________________________  No. of Shares ________________________  Dollar Amount $_______________________  Subject to Debt Yes No If so, amount $ _______________  Owners _________________________________________________________________ B. Marketable Securities  Issuer _____________________________________  Type _______________________________________  No. of Shares ________________________  Dollar Amount $_______________________  Subject to Debt Yes No If so, amount $ _______________  Owners _________________________________________________________________ Description of Other Assets Value Subject to Debt? Owner(s) ___________________________ $__________ ___________ _________________ ___________________________ $__________ ___________ _________________ ___________________________ $__________ ___________ _________________ ___________________________ $__________ ___________ _________________ Total Assets $_______________ Creditors Type of Debt Original Monthly Past Due? Balance Payments Yes/No? 1. Creditor _____________________________________  Landlord Mortgagee  Amount of Rent ________________ or Account No.__________________  Name in which account is carried ______________________________________________  If Mortgage Loan or other loan, original amount of debt $___________________________  Present Balance (if loan) $____________________________  Monthly Payments $_________________________  Past Due Yes No 2. Creditor ____________________________________  Landlord Mortgagee  Amount of Rent ________________ or Account No.__________________  Name in which account is carried _________________________________________  If Mortgage Loan or other loan, original amount of debt $___________________________  Present Balance (if loan) $____________________________  Monthly Payments $_________________________  Past Due Yes No 3 . Creditor _____________________________________  Landlord Mortgagee  Amount of Rent ________________ or Account No.__________________  Name in which account is carried _________________________________________  If Mortgage Loan or other loan, original amount of debt $___________________________  Present Balance (if loan) $____________________________  Monthly Payments $_________________________  Past Due Yes No 4. Creditor _____________________________________  Landlord Mortgagee  Amount of Rent ________________ or Account No.__________________  Name in which account is carried _________________________________________  If Mortgage Loan or other loan, original amount of debt $___________________________  Present Balance (if loan) $____________________________  Monthly Payments $_________________________  Past Due Yes No Total Debts $______________________ Credit References: (Names and addresses of each) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Are you a co-maker, endorser, or guarantor on any loan or contract? Yes No If "yes" for whom? ______________________________________________ (name of debtor) To whom? ________________________________________________ (name of creditor) Are there any unsatisfied judgments against you? Yes No If "yes" to whom owed? (List name(s) of creditor(s) for whom there are unsatisfied judgments) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Have you been declared bankrupt in the last 14 years? Yes No If "yes" where? _____________________________________________________________________ _________________________________________________________________ (Place of bankruptcy) Year __________________ (year of bankruptcy) Other Obligations -- (E.g., liability to pay alimony, child support, separate maintenance. Use separate sheet if necessary.) (List details of other obligations) ________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. Witness my/our signature(s), this the _____ day of ____________________________, 20_____. ____________________________________ Applicant ____________________________________ Applicant