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Credit Application (Form B)
CREDIT APPLICATION-FORM B
Legal name of applicant: [Legal name of applicant]
Present address: [Present address]
Home phone: [Home phone]
Work Phone: [Work Phone]
HOME DATA
Do you rent or own your present address?
[Do you rent or own your present address?: rent/own]
How long have you lived at your present address?
[How long have you lived at your present address?]
Previous addresses and periods when you lived there:
[Previous addresses and periods when you lived there]
WORK DATA
Name of employer and address:
[Name of employer and address]
How long have you worked for this employer?
[How long have you worked for this employer?]
BUSINESS DATA
What type of business are you engaged in?
[What type of business are you engaged in?]
Name and address of business:
[Name and address of business]
How long have you owned this business?
[How long have you owned this business?]
What is the legal organization of this business?
[What is the legal organization of this business?]
If either employment or business has been of less than one (1) year duration, what was your prior working/business affiliation?
[What was your prior working/business affiliation?]
ANNUAL INCOME
Gross income from work or business?
[Gross income from work or business?]
Overtime or outside income?
[Overtime or outside income?]
Interest and/or dividends?
[Interest and/or dividends? ]
Commissions or fees?
[Commissions or fees? ]
Rentals from property?
[Rentals from property? ]
Other Income?
[Other Income?]
TOTAL ANNUAL INCOME
[Total annual income]
ESTIMATED VALUE OF YOUR POSSESSIONS
Equity in home
[Equity in home]
Equity in other property
Car(s)
[Equity in Car(s)]
Savings
[Equity in Savings]
Stocks/bonds
[Equity in Stocks/bonds]
TOTAL ASSETS
[Total assets]
ESTIMATED DEBTS
Mortgage balance
[Mortgage balance]
Car loan
[Car loan]
Bank loan
[Bank loan]
Credit card(s)
[Credit card(s)]
Other
[Other]
TOTAL DEBTS
[Totals debts]
BANKRUPTCY
Have you ever found it necessary to declare bankruptcy during the past five (5) years?
[Have you ever found it necessary to declare bankruptcy during the past five (5) years? Yes/no]
What was the date?
[What was the date?]
CERTIFICATION
I certify the aforegoing information to be accurate and complete to the best of my knowledge and hereby authorize the disclosure and release of any credit-related information based on this application to [Release credit info to]
Dated [Dated signed]
Signed