(Community property)

CREDIT APPLICATION

IMPORTANT:Read these directions before completing this Application.


If you are applying for individual credit in your own name, are not married, and are not relying on alimony, child support, or separate maintenance payments or on the income or assets of another person as the basis for repayment of the credit Box requested, complete only Section A ans D. If the requested credit is to be secured, also complete Section E.

In all other situations, complete all Sections except E, providing information in B about your spouse, a joint application or user, or the person on whose alimony, support, or maintenance payments or income or assets you are relying on. If the requested credit is to be secured, also complete Section E.

Amount Request

Payment Date Required

Proceeds of Credit

Section A-Information Regarding APPLICANT

Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for this obligation.

Alimony, child support or separate maintenance received under:

If any income listed in this Section likely to be reduced in the next two year or before the credit requested is paid off?

Section B-Information Regarding Spouse, joint applicant, user, or other party

Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for this obligation.

Alimony, child support or separate maintenance received under:

If any income listed in this Section likely to be reduced in the next two year or before the credit requested is paid off?

Section C-Marital Status

Section D-Asset and debt information

(If sec B has been completed. This section should be completed giving information about both the applicant and spouse. joint applicant, user or other person. Please mark Applicant-related information with an "A" if section B was not completed only give information about the applicant in this section.)

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Other Signature (Where Applicable) *  x
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