Important Applicant Information
Important: Please check the appropriate boxes below and complete the applicable sections.
Want to Repay
Do you currently:
Complete if less than 3 years at present address
Name and Address of Nearest Relative Not Living with You
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis of repaying this obligation.
Alimony, child support, separate maintenance received under:
Is any income listed in this Section likely to be reduced before the credit request is paid off?
Have you previously received credit from us?
Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.
Has Joint Applicant or Other Party ever received credit from us?
Complete ONLY if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested.
If Section B has been completed, this Section should be completed giving information about both the Applicant and Joint Applicant 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
Name in Which the Account is Carried
Subject to Debt?
Including charge accounts, installment contracts, credit cards, rent, mortgages, etc.
Total Original Amount
Total Present Balance
Total Monthly Payments
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable).
Are you a co-maker, endorser, or guarantor on any loan or contract?
Are there any unsatisfied judgements against you?
Have you been declared bankrupt in the last 10 years?
Are you obligated to make Alimony, Support or Maintenance Payments?
Names and addresses of all co-owners of the property
If the security is real estate, give the full name of your spouse (if any)
Notice to All Applicants. A Consumer Report may be requested in connection with this application for credit or any future update, renewal, or extension of such credit. Upon request, you will be informed whether or not a consumer report was requested. If a report was requested, you will be informed of the name and address of the consumer reporting agency that furnished the report.
Notice to Ohio Residents. The Ohio laws against discrimination require that all creditors make credit equally available to all credit-worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law.
Notice to Wisconsin Residents - Marital Property Agreement Notice. No provision of any marital property agreement, unilateral statement under Wisconsin Statutes Section 766.59 or court decree under Wisconsin Statues Section 766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.
I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By signing below I authorize Lender to check my credit and employment history and to answer questions others may ask Lender about my credit record with Lender. I understand that I must update credit information at Lender's request if my financial condition changes.
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