Individual Credit Application Form

Referred by: _____________________________________________ Date: ______________________

Application No.: _______________

ITEM

Vehicle Model: _________________Price: ____________ Down Payment: _____ Amount Financed: _________ Terms: __________ Sales Rep.: _________________

Service

Parts

Accessories

Credit Limit: _______________________

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APPLICANT

LAST NAME: __________________________________ FIRST NAME: _______________________________ MIDDLE NAME: _________________________________

APPLICANT’S BIRTH DATE : _____________________________

CIVIL STATUS ________________________ NO. OF DEPENDENTS: __________________

Co-Maker: _________________________________ SPOUSE’S BIRTH DATE: ______________________ TELEPHONE NO: ________________________________

HOME ADDRESS: ________________________________________________________________________________________________________________________

PROVINCIAL ADDRESS: (if any) _____________________________________________________________________________________________________

Rented

Owned

Living with relatives

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(PREVIOUS ADDRESS IF LENGTH OF STAY IN PRESENT RESIDENCE IS LESS THAN 2 YEARS)

____________________________________________________________________________________________________________________________

EMPLOYMENT

PRESENT EMPLOYER

OWNS BUSINESS

EMPLOYER OF SPOUSE

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□

OWNS BUSINESS

___________________________________________________.______________

___________________________________________________________________

BUSINESS ADDRESS ______________________________________________

ADDRESS _________________________________________________________

_____________________________________________________________

_____________________________________________________________

TEL. NO. ________________ YRS.W/ CO. ________ POSITION _____________

TEL. NO. __________ YRS.W/ CO. _________ POSITION ___________________

PREVIOUS EMPLOYER

YEARS WITH COMPANY _______

PREVIOUS EMPLOYER

YEARS WITH COMPANY _______

______________________________________ TEL. NO. ________________

______________________________________ TEL. NO. ________________

ADDRESS _____________________________________________________

ADDRESS _____________________________________________________

NET INCOME

APPLICANTS MONTHLY SALARY

________________________________

MONTHLY EXPENSES

___________________________________

P

________________________________

RENTALS

___________________________________

MOTHER’S MONTHLY SALARY

MORTGAGES

__________________________

OTHER MONTHLY INCOME

________________________________

____________________________

FROM

________________________

___________________________________

_________________________

____________________________

TOTAL EXPENSES

___________________________________

_________________________

__________________________

_________________________

NET MONTHLY INCOME

P

________________________________

TOTAL MONTHLY INCOME

P

PERSONAL & CREDIT REFERENCES

NAMES OF CHILDREN/DEPENDENTS

AGE

SCHOOL

GRADE/LEVEL

NEAREST RELATIVE NOT LIVING WITH YOU

RELATIONSHIP

ADDRESS

TEL. NO/S.

PERSONAL REFERENCES

RELATIONSHIP

ADDRESS

TEL. NO/S.

CREDIT REFERENCES

ADDRESS/TEL.NO.

ACCT. NO.

LOAN TYPE

MO. AMORT.

O/S BAL.

SAVINGS ACCOUNT AT

NO.

CURRENT ACCOUNT

NO.

CREDIT CARDS AT

NO.

AT

Res. Cert. ____________________ Issued at __________________ Date _______________ TIN ______________________ SSS No. ____________________

ACR No. _____________________ Issued at __________________ Date _______________ Verification O.R. No. ____________________ Date ____________

I hereby certify that all data and statements in this application are correct and complete, and are made for the purpose of obtaining credit, and the signatures appearing

hereon are genuine. I authorize you to obtain such information as you may require concerning the statements made in this application and that the sources from which you

may verify are authorized to provide any information relative to this application. I agree that the application may remain your property whether the credit is granted or not.

LOAN STATUS

APPROVED

DECLINED

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CONDITIONS:

SIGNATURE OF APPLICANT

_________________________________________________________________________________________

______________________________________________

_________________________________________________________________________________________

SIGNATURE OF SPOUSE

_________________________________________________________________________________________

_________________________________________________________________________________________

OFFICER: ___________________________ OFFICER CODE: _________________ DATE: ______________