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  1.  
  2.  
  3.                                 CREDIT APPLICATION
  4.  
  5.  
  6.         Name:                                 Date:
  7.  
  8.  
  9.         Present Address:                      No. Years:
  10.  
  11.  
  12.                                               Own or Rent:
  13.  
  14.                                               No. of Dependents:
  15.  
  16.  
  17.         Name and address of employer:
  18.  
  19.         Years employed in this type of work or profession:
  20.  
  21.         Years on this job:
  22.  
  23.         Position/Title:
  24.  
  25.         Type of business:
  26.  
  27.         Home phone:
  28.  
  29.         Business phone:
  30.  
  31.         Gross monthly income:
  32.  
  33.         Base employment income:
  34.  
  35.         Overtime:
  36.  
  37.         Bonuses:
  38.  
  39.         Commissions:
  40.  
  41.         Dividends/Interest:
  42.  
  43.         Net Rental Income:
  44.  
  45.         Other Sources:
  46.  
  47.         (Alimony, child support or separate maintenance income need not 
  48.         be revealed if the Borrower does not choose to have it considered 
  49.         as a basis for repaying this loan.)
  50.  
  51.                 If employed in present position less than two years 
  52.         state:
  53.  
  54.                 Previous employer:
  55.  
  56.                 Type of business:
  57.  
  58.                 Position:
  59.  
  60.                 Dates from/to:
  61.  
  62.                 Monthly income:
  63.  
  64.                 Have you declared or been declared bankruptcy in the past 
  65.                 five years?:
  66.  
  67.                 Are you a party to any lawsuit?:
  68.  
  69.  
  70.                      ASSETS                           DEBTS
  71.         
  72.         
  73.                 Checking and Savings Accounts         Loans
  74.  
  75.                 Stocks and Bonds                      Notes
  76.  
  77.                                                       Credit Cards
  78.  
  79.                 Real Estate Owned
  80.  
  81.                 Retirement Fund
  82.  
  83.                 Net Worth of Business Owned
  84.  
  85.                 Automobile (make and year)
  86.  
  87.                 Other
  88.  
  89.  
  90.                                     ___________________________________
  91.                                     Borrower
  92.  
  93.  
  94.                                                         Form 122
  95.  
  96.