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[BUSINESS] Consumer Credit Application Form

[BUSINESS] Consumer Credit Application Form

Please complete the following.

[ENTER BUSINESS NAME, ADDRESS]
Phone: (123) 456-6789
Email: YourName@YourEmail.com
Website: YourWebsite.com

PRIMARY APPLICANT INFORMATION

Please complete the following
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Your Name * First Middle Last
Address *
Address Type Street Address Address Line 2 Apartment City State / Province / Region Postal / Zip Code Country
How long have you lived at the address? *
Email Address
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Confirm Email *
Home phone * - ### - ### ####
Date of birth (DD/MM/YY) *
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Age *
Social Insurance Number (or Social Security Number for US) *
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Regarding your home, do you: *
Own Rent/lease Live with a relative Other
Mortgage/Rent monthly payment? (if applicable)
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PRIMARY APPLICANT EMPLOYMENT

Please complete the following
Current Employer name *
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How long have you worked here? *
Employer address *
Address Type Street Address Address Line 2 Apartment City State / Province / Region Postal / Zip Code Country
Work phone * - ### - ### ####
Position/Title *
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Gross annual income *
Other sources of income (e.g. alimony, child support, or separate maintenance income need not be disclosed if you do not wish to have it considered for repaying this obligation)
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Annual income amount
Previous Employer or School (only if current employment is less than 2 years) *
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How long did you work there, or attend school? *
PRIMARY APPLICANT REFERENCES

Enter at least one reference:
Reference #1 name * First Last
Telephone * - ### - ### ####
Your relationship to Reference #1 *
Family Friend Co-worker Other
Reference #2 name First Last
Telephone - ### - ### ####
Your relationship to Reference #2
Family Friend Co-worker Other
Reference #3 name First Last
Telephone - ### - ### ####
Your relationship to Reference #3
Family Friend Co-worker Other
Nearest relative not living in your household * First Last
Telephone * - ### - ### ####
Your relationship to relative *
Cousin Brother-in-law Sister-in-law Parents-in-law Other
CO-APPLICANT INFORMATION (IF APPLICABLE)

IF THERE IS NO CO-APPLICANT, SKIP THE SECTION BELOW AND SCROLL DOWN TO "ACKNOWLEDGEMENT AND CONSENT" BEFORE SIGNING
Your Name First Middle Last
Address
Address Type Street Address Address Line 2 Apartment City State / Province / Region Postal / Zip Code Country
How long have you lived at the address?
Email Address
Scan Barcode

Confirm Email *
Home phone - ### - ### ####
Date of birth (DD/MM/YY)
Scan Barcode
Age
Social Insurance Number (or Social Security Number for US)
Scan Barcode
Regarding your home, do you:
Own Rent/lease Live with a relative Other
Mortgage/Rent monthly payment? (if applicable)
Scan Barcode
Current Employer name
Scan Barcode
Employer address
Address Type Street Address Address Line 2 Apartment City State / Province / Region Postal / Zip Code Country
How long have you worked here?
Work phone - ### - ### ####
Position/Title
Scan Barcode
Gross annual income
Other sources of income (e.g. alimony, child support, or separate maintenance income need not be disclosed if you do not wish to have it considered for repaying this obligation)
Scan Barcode
Annual income amount
Previous Employer or School (only if current employment is less than 2 years)
Scan Barcode
How long did you work there, or attend school?
ACKNOWLEDGEMENT AND CONSENT

NOTICE: I, the Undersigned, hereby authorize the [ENTER ORGANIZATION NAME] and and/or “prospective creditors” to verify credit and employment history as stated above and to answer questions about credit experience with me.

If this application is made pursuant to any credit program for attendees and/or graduates of schools or educational institutions, then prospective creditors may verify my eligibility for such program, including by inquiry to my school(s) or educational institution(s).

In connection with this application for credit, prospective creditors may request a consumer (credit) report. On my request, prospective creditors will advise me if the report was actually ordered and if so, the name and address of the agency that furnished the report. Prospective creditors may order subsequent consumer (credit) reports.

I authorize prospective creditors to ask my past and current creditors (”credit references”), including creditors listed above or on my consumer (credit) report, about my credit performance with them. Provision by prospective creditors of a copy of this authorization shall serve as my direction that my credit references provide my credit performance information.

Everything that I have stated in this application is complete and correct to the best of my knowledge and constitutes my entire application for credit with the prospective creditors. I understand that prospective creditors will retain this application whether or not it is approved. I will notify prospective creditors, if applicable, within a reasonable time of any change in my name, address or employment.

To the extent permitted by law, i consent that you, your assignees, and your agents may contact me at any telephone number you have for me, including any cell phone numbers and any phone numbers listed on this document, by any means you select, including an automatic telephone dialing system, text messaging, and/or an artificial or pre-recorded voice.

We warrant to [ENTER ORGANIZATION NAME] that neither a bankruptcy proceeding nor a proposal is now or about to be made about us.

We warrant to [ENTER ORGANIZATION NAME] that the information we have given to prospective creditors in this application is true and correct.

Please sign below
Signature of Primary Applicant *

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Signed on this date * / MM / DD YYYY
Signature of Co-applicant (if applicable) NOTE: CO-APPLICANT’S SIGNATURE MEANS YOU INTEND TO APPLY FOR JOINT CREDIT.

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Signed on this date / MM / DD YYYY