Wickersheim Plumbing - Credit Application Form

Credit Application Form

Personal Loan -- Wickersheim Plumbing
INDIVIDUAL: I am applying for indiviidual credit in my own name and I am relying on my own income and assets.
Applicant Name
Date

MonthDayYear
Date
Applicant's Information
FIRST NAME
INITIAL
LAST NAME
DATE OF BIRTH

MonthDayYear
SOCIAL SECURITY NUMBER
HOME ADDRESS (NUMBER & STREET)
CITY
STATE
ZIP
HOW LONG?
HOME PHONE
PREVIOUS ADDRESS (If not at present address for 5 years)
HOW LONG?
EMPLOYED BY (If Self Employed: Type of Business)
HOW LONG?
BUSINESS PHONE
ADDRESS

ADDRESS

Street Address Line 2

CITYSTATE

Postal / Zip Code
POSITION
PREVIOUS EMPLOYER
CITY
STATE
HOW LONG?
POSITION
Income Information
ANNUAL SALARY
BONUS & COMMISSION
OTHER INCOME (LIST SOURCE)
OTHER INCOME (A)
OTHER INCOME (B)
TOTAL ANNUAL INCOME
NOTE: ALIMONY. CHILD SUPPORT AND SEPARATE MAINTENANCE PAYMENTS NEED NOT BE REVEALED UNLESS YOU WISH TO RELY ON SUCH INCOME IN APPLYING FOR CREDIT. IF YOU ARE RELYING ON ALIMONY. CHILD SUPPORT OR SEPARATE MAINTENANCE PAYMENTS FROM SPOUSE/CIVIL UNION PARTNER OR FORMER SPOUSE/CIVIL UNION PARTNER AS A BASIS FOR REPAYMENT OF THE CREDIT YOU ARE APPLYING FOR, BE SURE TO COMPLETE THE "OTHER INCOME" SECTION BELOW.
Everything that have stated in this application is correct to the best of my knowledge. I understand that Valley National Bank will retain this application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.
Applicants Signature

Clear
Date

MonthDayYear
Date
Email Address
example@example.com
Should be Empty:

Credit Application Form

Applicant's Information

Income Information