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Consumer Credit Application
CONSUMER CREDIT APPLICATION
Last Name: [Last Name of applicant]
First Name: [First Name of applicant]
Social Security No. [Social Security No]
DOB: [DOB]
Street: [Street]
City: [City]
State: [State]
Zip Code: [Zip Code]
Telephone: [Telephone]
Employer: [Employer]
Employer's Address: [Employer's Address]
Gross Salary: [Gross Salary] [ Wk. Mo. Yr. ]
Length Of Employment: [Length Of Employment] [Years/Months]
Position: [Position]
Additional Income: [Additional Income]
Source of Additional Income: [Source of Additional Income]
Number Of Dependents: [Number Of Dependents]
Home: [Owned/Rented/Live with parents]
Mortgage holder or Landlord: [Mortgage holder or Landlord]
Monthly Payment: [Monthly Payment]
Did you ever declare bankruptcy or have a judgment filed against you?
[Judgement? Yes/No]
If yes, list the:
Court [Court] and date: [court date]
Checking Account #: [Checking Account #]
Savings Account #: [Savings Account #]
Bank Name and Address:
1. [account number 1, balance and monthly payment of Credit Cards]
2. [account number 2, balance and monthly payment of Credit Cards]
3. [account number 3, balance and monthly payment of Credit Cards]
The information contained in this application is true and correct, and is supplied to obtain credit from you. I authorize you to verify any and every aspect of the information in the application and any additional information that you may require in connection with this application or in connection with any review, update, extension, renewal or collection of any credit you extend as a result of this application. I hereby authorize you to report your credit experience with me to other retail establishments and credit-reporting agencies.
Applicant 1 Signature: Date:
Applicant 2 Signature: Date: