Sample Consumer Credit Application
APPLICATION INFORMATION
Full Legal Name ______________________________
Date of Birth _____________ US Citizen? (Y/N): ________
Social Security Number _______________________________
Current Street Address: _______________________________ City:
Home Phone with area code: ___________________________
Own/Rent/Other _________ Monthly Payment ____________
Landlord/Mortgage Company __________________________
Business Phone with area code: _________________Self-Employed? (Y/N): _________
Business/Employer: __________________________________
Occupation: _____________________________
Length of Employment_____________________
Previous Employer if less than 2 years with current:
__________________________________________________
Occupation: ________________________________________
Length of Employment: ____________________
Gross Monthly Income: ____________________
Additional Month Income and Source: ____________________
CO APPLICATION OR OTHER PARTY INFORMATION
Full Legal Name _______________________ Relationship to App. _______________
Date of Birth: _________________
Home Phone with area code: ___________________________
Own/Rent/Other _________ Monthly Payment ____________
Landlord/Mortgage Company __________________________
Business Phone with area code: _________________Self-Employed? (Y/N): _________
Business/Employer: __________________________________
Occupation: _____________________________
Length of Employment_____________________
Previous Employer if less than 2 years with current:
__________________________________________________
Occupation: ________________________________________
Length of Employment: ____________________
Gross Monthly Income: ____________________
Additional Month Income and Source: ____________________
APPLICANT(S) acknowledges the following:
I/We agree that by either signing, faxing, sending electronically or otherwise submitting this application [PUT YOUR COMPANY NAME HERE] is authorized to investigate my/our credit and employment history and to share this application with third parties who may also investigate my/our credit and employment history for the purposed of obtaining credit. I/We certify the information given is true and correct.
________________________________ ________________________________
Applicant Signature Date Co-Applicant Signature Date
