| Amount Requested: |
|
| Personal Information: |
| Full Name: |
|
| Social Security #: |
|
| Date of Birth: |
|
| # of Dependents: |
|
| Address: |
|
| City: |
|
| State: |
Zip:
|
| Phone: |
|
| Time At Address: |
Years:
Months:
|
| Previous Address: (if less than 2 years
at current address) |
| Address: |
|
| City: |
|
| State: |
Zip:
|
| Phone: |
|
| Time At Address: |
Years:
Months:
|
| Employer: |
| Employer Name: |
|
| Position: (Title, or Rank) |
|
| Employment Duration: |
Years:
Months:
|
| Work Phone: |
|
| Salary: |
Per:
|
| Previous Employer: (if less than 2 years
at currnet employer) |
| Employer Name: |
|
| Position: (Title, or Rank) |
|
| Employment Duration: |
Years:
Months:
|
| Work Phone: |
|
| Salary: |
Per:
|
| Other Income: Income from alimony, child
support, or separate maintenance payments need not be disclosed
if you do not wish to have it considered as a basis for repaying
this obligation. |
| Amount |
Per:
|
| Source: |
|
| Other Information: |
| Have you ever declared Bankruptcy:
Yes
No |
|
Do you have: (Check all that apply)
Checking Account(s)
Savings Account(s)
|
| Do you:
Rent
Own/Buying |
| Landlord/Mortgage Holder: |
|
| Monthly Payment: |
|
| If you Own or are Buying: |
| Current Home Value: |
|
| Mortgage Balance: |
|
Co-Applicant Information:
Complete co-applicant information if you are a MARRIED WISCOUNSIN
RESIDENT or INDIVIDUAL CREDIT (but relying on income of another) |
| Co-Applicant's Full Name: |
|
| Social Security #: |
|
| Date of Birth: |
|
| Address: |
|
| City: |
|
| State: |
Zip:
|
| Phone: |
|
| Employer Name: |
|
| Position: (Title, or Rank) |
|
| Employment Duration: |
Years:
Months:
|
| Work Phone: |
|
| Salary: |
Per:
|
| Nearest Relative not living with
you: |
|
| Relative's Address: |
|
| Relative's City: |
|
| Relative's State: |
Zip:
|
FAIR CREDIT REPORTING ACT NOTICE TO CUSTOMER:
Buyer's credit application will be submitted for consideration
to CitiFinancial Retail Services Division of Travelers Bank
& Trust, fsb or one of its affiliates, Home Office, 300
St. Paul Place, Baltimore, MD 21202.
Notice to Applicant: A consumer report
may be requested with the processing of you credit. Upon
request, you will be informed whether or not a consumer
report was requested and, if such report was requested,
informed of the name and address of the consumer reporting
agency that furnished this report. Subsequent consumer reports
may be requested or utilized in connection with and update,
renewal, or extension of credit or collection.
I/We authorize you to investigate credit and employment
history and understand that if I/we do not qualify for the
requested amount, you may consider me for a lesser amount.
|
|
If this application is approved you agree
to all the terms and conditions of the attached
Agreement (Form 25596-F (04/01)), which are incorporated
herein by reference.
BUYER'S RIGHT TO CANCEL: IF THIS BOX IS CHECKED, YOU, THE
BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO
MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THE
TRANSACTION.
CAUTION: IT IS IMPORTANT THAT YOU THOROUGHLY
READ THE CONTRACT BEFORE YOU SIGN IT.
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| |
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