Credit Application

Will there be a co-applicant? Yes No
Married couples must enter spousal information. WI is a community property state.

Primary Applicant

Contact Information and Personal Data

First Name:

MI:

Last Name:

Date of Birth :

Social Security Number:
- -

Primary Phone: This is my	Secondary Phone: This is my
Email:	How many dependents do you claim on your taxes?

Address Information

Address:

Street:
Street 2:
City:
Zip:	State:

Years Lived Here:
Years Months

Owned Rented Other

Rent/Mortgage
$ Weekly Monthly

Landholder/Lienholder

Rent/Mortgage shared with:
paying $

Primary Employer

Employer Name:

Address:

Street:
Street 2:
City:
Zip:	State:
Main Phone:
Your #/Ext:

Whom may we contact to verify employment?

Your Position:

Years Worked Here:
Years Months

Net Income
$ per Week 2-Weeks

Do you have any garnishments or child support taken out of your check?

Net Income is your check amount (take home). Total income minus all taxes, deductions
and garnishments (e.g. child support, alimony)

Secondary Employer (if applicable)

Employer Name:

Address:

Street:
Street 2:
City:
Zip:	State:
Main Phone:
Your #/Ext:

Whom may we contact to verify employment?

Your Position:

Years Worked Here:
Years Months

Net Income
$ per Week 2-Weeks

Do you have any garnishments or child support taken out of your check?

Net Income is your check amount (take home). Total income minus all taxes, deductions
and garnishments (e.g. child support, alimony)

Only fill out this section if you've worked at your primary employer for less than one (1) year.

Previous Employer (if applicable)

Employer Name:

Address:

Street:
Street 2:
City:
Zip:	State:
Main Phone:
Your #/Ext:

Whom may we contact to verify employment?

Your Position:

Years Worked Here:
Years Months

Net Income
$ per Week 2-Weeks

Do you have any garnishments or child support taken out of your check?

Net Income is your check amount (take home). Total income minus all taxes, deductions
and garnishments (e.g. child support, alimony)

Co-Applicant

Contact Information and Personal Data

First Name:

MI:

Last Name:

Date of Birth :

Social Security Number:
- -

Primary Phone: This is my	Secondary Phone: This is my
Email:	Relationship to Primary Applicant:

Address Information

Address:

Street:
Street 2:
City:
Zip:	State:

Years Lived Here:
Years Months

Owned Rented Other

Rent/Mortgage
$ Weekly Monthly

Landholder/Lienholder

Rent/Mortgage shared with:
paying $

Primary Employer

Employer Name:

Address:

Street:
Street 2:
City:
Zip:	State:
Main Phone:
Your #/Ext:

Whom may we contact to verify employment?

Your Position:

Years Worked Here:
Years Months

Net Income
$ per Week 2-Weeks

Do you have any garnishments or child support taken out of your check?

Net Income is your check amount (take home). Total income minus all taxes, deductions
and garnishments (e.g. child support, alimony)

Secondary Employer (if applicable)

Employer Name:

Address:

Street:
Street 2:
City:
Zip:	State:
Main Phone:
Your #/Ext:

Whom may we contact to verify employment?

Your Position:

Years Worked Here:
Years Months

Net Income
$ per Week 2-Weeks

Do you have any garnishments or child support taken out of your check?

Net Income is your check amount (take home). Total income minus all taxes, deductions
and garnishments (e.g. child support, alimony)

Only fill out this section if you've worked at your primary employer for less than one (1) year.

Previous Employer

Employer Name:

Address:

Street:
Street 2:
City:
Zip:	State:
Main Phone:
Your #/Ext:

Whom may we contact to verify employment?

Your Position:

Years Worked Here:
Years Months

Net Income
$ per Week 2-Weeks

Do you have any garnishments or child support taken out of your check?

Net Income is your check amount (take home). Total income minus all taxes, deductions
and garnishments (e.g. child support, alimony)

Loan Information

Loan Amount Requested $	Where did you hear about us?
What will you use the loan for?	If you have collateral, please describe it here:
Have you ever filed for bankruptcy?	If yes, was it discharged?
Promotional or Referral Code

Consent to Terms & Submit Application

Do you accept the terms and agree to release employment info?