Professional Documents
Culture Documents
Applicant Information
First Name: Middle Initial: Last Name:
Social Security Number: Date of Birth: Number of Dependents: Driver's License Number:
Former Address if above address is less than 7 years: City: State: Zip: How Long:
Employment
Current Employer: How Long: Position/Title: Monthly
Salary:
Co-Applicant Information
First Name: Middle Initial: Last Name:
Additional Income
Additional Source of Income: Monthly Amount:
(Continued)
10/99 SMS-008
References List Banks, Stores, Charge Cards, etc.
Account With Address Account Number Balance Owing Monthly Payment
Checking
Savings
Mortgage
Auto Loan
Credit
Acct. #1
Credit
Acct. #2
Credit
Acct. #3
The above information is correct and is given for the purpose of obtaining credit. You are authorized
to verify this information and to obtain additional information in reviewing this credit request.
Both Signatures are Required for a Joint Application
Has the applicant established credit as defined in the Cooperative’s rules? YES NO
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Cooperative Representative Date
10/99 SMS-008