Consumer Credit Application Page 2
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1
2MARITAL STATUS
Complete only if: for joint credit, or applicant resides in a community property state or is relying on property located in such state as a basis for repayment of the credit requested.
APPLICANT
Married
Separated
Unmarried (including single, divorced and widowed)
OTHER PARTY
Married
Separated
Unmarried (including single, divorced and widowed)
ASSET AND DEBT DETAILS
If this is a joint application please mark all applicant related information with an "A", otherwise only give information about the applicant in this section.
ASSETS OWNED
DESCRIPTION OF ASSETS
ACCOUNT HOLDERS
SUBJECT TO DEBT?
VALUE IN $
CHECKING ACCOUNT
No
(where)
SAVINGS ACCOUNT
No
(where)
CERTIFICATE(S) OF DEPOSIT
No
(where)
MARKETABLE SECURITIES
No
(issuer, type, # of shares)
REAL ESTATE
No
(location)
LIFE INSURANCE
No
(issuer, face value)
AUTOMOBILE(S)
No
(year, make, model)
OTHER
No
(list)
$0.00
OUTSTANDING DEBTS
CREDITOR
ACCOUNT NUMBER
PRESENT BALANCE
MONTHLY PAYMENTS
N/A
N/A
LANDLORD:
MORTGAGE HOLDER:
AUTOMOBILE
(creditor)
AUTOMOBILE
(creditor)
CREDIT CARD
CREDIT CARD
OTHER
(describe)
OTHER
(describe)
$0.00
$0.00
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable)
Applicant
Joint Applicant
Are you obligated to make Alimony, Support or Maintenance Payments?
No
Yes
No
Yes
Applicant: If yes, to (Name & Address) ____________________________________________________________
Amount per month $____________________
Joint Applicant: If yes, to (Name & Address) ________________________________________________________
Amount per month $____________________
Are you a co-maker, endorser or guarantor on any loan or contract?
No
Yes
No
Yes
Applicant: If yes, for whom? ____________________________________________ To whom? ______________________________________________________
Joint Applicant: If yes, for whom? _______________________________________
To whom? ______________________________________________________
Are there any unsatisfied judgments against you?
No
Yes
No
Yes
Applicant: If yes, to whom owed __________________________________________________________________
Amount $ ____________________________
Joint Applicant: If yes, to whom owed _____________________________________________________________
Amount $ ____________________________
Have you been declared bankrupt in the last 10 years?
No
Yes
No
Yes
Applicant: If yes, where _________________________________________________________________________
Year? _______________________________
Joint Applicant: If yes, where ____________________________________________________________________
Year? _______________________________
SIGNATURES - I certify that everything I have stated in this application and on any attachments is correct. Charter Bank may keep this application whether or not it is approved.
By signing below I authorize Charter Bank to check my credit and employment history and to answer questions others may ask Charter Bank about my credit record with Charter Bank.
I understand I must update credit information at Charter Bank's request if my financial condition changes.
X
X
Applicant's Signature
Date
Other Signature (If Applicable)
Date
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Parent category: Business