1. Type of Application


2. Type of Requested Credit

Financing Type

Repayment Interval

Credit Type

Loan Purpose

Security for Credit

Proceeds of Credit to be Used for


3. Applicant Information

Applicant

Present Address

Previous Address

Dependents

Nearest Relative (not living with you)

Your Relationship with us (or our affiliate)

Have you ever received credit from us?

Joint Applicant

Present Address

Previous Address

Dependents

Nearest Relative (not living with you)

Your Relationship with us (or our affiliate)

Have you ever received credit from us?

 


4. Asset and Debt Information

If the "Joint Applicant" or "Other Party" Sections were completed, this Section should be completed by giving information about both the Applicant, and the Joint Applicant or Other Party, if applicable.

Assets Owned

 

Outstanding Debts

This section should be charge accounts, installment contracts, credit cards, rent, mortgages, and other obligations.
 


5. Employment Information

Applicant

1st Employer

2nd Employer

3rd Employer

Joint Applicant

1st Employer

2nd Employer

3rd Employer

 


6. Other Income

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.

Applicant

Alimony, child support, separate maintenance received under:

Is any Income listed in Sections 4, 5, or 6 likely to be reduced before the credit is paid off

Joint Applicant

Alimony, child support, separate maintenance received under:

Is any Income listed in Sections 4, 5, or 6 likely to be reduced before the credit is paid off

 


7. Other Obligations

Applicant

Are you a co-maker, endorser, co-signer, surety, or guarantor on any loan, contract or other obligation?

If yes,

Are there any unsatisfied judgements against you?

If yes,

Have you been declared bankrupt in the last 10 years?

If yes,

Are you obligated to make Alimony, Support, or Maintenance Payments?

If yes,

Joint Applicant

Are you a co-maker, endorser, co-signer, surety, or guarantor on any loan, contract or other obligation?

If yes,

Are there any unsatisfied judgements against you?

If yes,

Have you been declared bankrupt in the last 20 years?

If yes,

Are you obligated to make Alimony, Support, or Maintenance Payments?

If yes,

 


8. Property Information (if secured)

Property Type

Property Info

 


9. Marital Status

Applicant

Leave blank, unless: (1) the credit will be secured, or (2) you reside in a community property state, or (3) you are relying on property, located in a community property state, as a basis for repayment.

Joint Applicant


10. Additional Information or Explanations

 


11. Notices

California Residents. Each applicant, if married, may apply for a separate account.

New York Residents. A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or not a report was ordered. If a report was ordered, we will tell you the name and address of the consumer reporting agency that provided the report. Subsequent reports may be ordered or utilized in connection with an update, renewal or extension of credit for which you have applied.

Ohio Residents. The Ohio laws against discrimination require all creditors make credit equally availible to all creditworthy 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. Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Texas Residents. The owner of the homestead is not required to apply the proceeds of the extension of credit to repay another debt except debt secured by the homestead or debt to another lender.

Wisconsin Residents. Notice to Married Applicants. No provision of any marital property engagement, unilateral statement under Wisc. Statuses § 766.59 or a court decree under Wisc. Statuses § 766.70 adversely affects the interests 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. For Married Wisconsin Residents, The credit being applied for, if granted, will be incurred in the interest of my marriage or family. I understand the Creditor may be required by law to give notice of this transaction to my spouse.

 

12. Certifications, Authorizations and Signatures

You certify that everything you have stated in this Credit Application and on any other documents submitted to us are true and correct to the best of your knowledge. You understand that you must update the information contained in this Credit Application if either your financial condition materially changes or we make a request to you orally or in writing. You understand that we will retain this Credit Application whether or not it is approved.

You authorize us to request one or more consumer reports, to check and verify your credit and employment history, and to answer questions others may ask us about our credit experience with you.

You authorize us to contact you using any of the telephone numbers listed on this Credit Application or that you subsequently provide us in connection with your credit account - regardless whether the number we use is assigned to a paging service, cellular telephone service, specialized mobile radio service, other radio common carrier service or any other service for which you may be charged for the call. You further authorize us to contact you through the use of voice, text and email and through the use of prerecorded/artificial voice messages or an automatic dialing device.

If checked, You further agree that you have signed this Credit Application with one or more electronic signatures. You intend your electronic signature to have the effect of your written in signature. You viewed and read the entire Credit application and notices before you signed it. You received a paper copy of this Credit Application after it was signed. You understand that this Credit Application is in the electronic form that we will keep. We may rely on, and enforce, this Credit Application in the electronic form or as a paper version of the electronic form.

Notice: It is a federal crime punishable by fine, imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provision of Title 18, United States Code § 1001, et seq.

By submitting this application, I/we authorize a consumer credit report and verify the statements in this application. Furthermore, I/we agree to be bound by the terms and conditions of the debit card, and the electronic funds transfer disclosure, copies of which will be mailed to the applicant if a card is granted. Receipt of terms and conditions, and disclosure, and acceptance of such terms will be conclusively presumed by use of the card. If this is a joint application, the undersigned shall be jointly and severally liable for any and all debit card transactions. Both parties must sign if a joint account is desired.