Section B - Joint Applicant or Other Party Information
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.
Do you
Did you
Employment
Alimony, child support, or
separate maintenance income need not be revealed if you
do not wish to have it considered as a basis for
repaying this obligation.
Alimony, child support, separate maintenance received under
Is any income listed in this section likely to be reduced before the credit requested is paid off?
Have you previously received credit from us?
Section D - Assets & Debt Information
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.
Assets Owned
(Use a separate sheet if necessary.)
- Description of Assets
- Name in Which the
Account is Carried
- Subject to Debt?
- Value
Outstanding Debts
(Include charge accounts, installment contracts,
credit cards, rent, mortgages and other obligations. Use
separate sheet if necessary.)
- Creditor
- Account Number
- Name in Which the Account is Carried
- Original Amount
- Present Balance
- Monthly Payments
Add Another Debt
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable):
Are you obligated to make Alimony, Support or Maintenance Payments?
Are you a co-maker, endorser, or guarantor on any loan or contract?
Are there any unsatisfied judgments against you?
Have you been declared bankrupt in the last 10 years?
Notice to Married Applicants:
No provision of any marital property agreement,
unilateral statement under Wisc. Statutes §766.59 or a
court decree under Wisc. Statutes §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.