P.O. Box 400 EGS
St. Thomas, USVI 00804
A married person may apply for individual credit, I am applying for (Check one box please) ___ JOINT CREDIT with another person, Complete entire application ___ INDIVIDUAL CREDIT, Complete only individual section. ___ INDIVIDUAL CREDIT, but relying on income of another. Complete entire application. The other person should sign under section labeled "Other Person" below. Notice to Wisconsin Applicants: YOU MUST DISCLOSE YOUR MARITAL STATUS: married: ______ unmarried: ______ legally separated: ______ If you are a married Wisconsin applicant, you must provide your spouses information as indicated even though your spouse may not be signing the contract. For married Wisconsin applicant: I acknowledge that the obligation described herein is being incurred in the interest of my marriage or family. yes ____ no ____ FIRST NAME: ______________________________________ M.I. ____ LAST NAME: ______________________________________ HOME PHONE: ( ) ________________ DATE OF BIRTH _____ _____ _____ SOC. SEC. NO. ______ ____ ________ ADDRESS: _________________________________________ APT: _______ CITY: _____________________ STATE: ____ ZIP: _______________ ADDRESS SINCE? MO. ____ YR. ____ BUY: ____ RENT: ____ OTHER: ____ PREVIOUS ADDRESS: ___________________________________________________ (street) (city) (state) (zip) EMPLOYER: ______________________________ SINCE: _______________ BUS. PHONE: ( ) ______________ MONTHLY GROSS SALARY $_____________ PREV. EMPLOYER: ____________ TO _______________
Income from alimony, child support or separate maintenance payments need not be disclosed if you do not wish to have it considered as basis for repaying this obligation. ADD'L MONTHLY INCOME: $_________________ SOURCE: ____________________ PLEASE TELL US IF YOU HAVE: CHECKING ACCOUNT? ______ (Y/N) SAVINGS ACCOUNT? ______ (Y/N) JOINT APPLICANTS FIRST NAME: ______________________________________ M.I. ____ LAST NAME: ______________________________________ HOME PHONE: ( ) ________________ DATE OF BIRTH _____ _____ _____ SOC. SEC. NO. ______ ____ ________ ADDRESS: _________________________________________ APT: _______ CITY: _____________________ STATE: ____ ZIP: _______________ DATE OF RESIDENCE: _________ (mm/yy) JOINT APPLICANTS EMPLOYER: ____________________________________ BUS. PHONE: ( ) ________________ MONTHLY GROSS SALARY: $_________________ SINCE: _________ (mm/yy) NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU: _________________________________________________________ RELATIONSHIP: ___________________________________________