1829 W. Jefferson
Plymouth, IN 46563
Tel. 574.948.0002
800 S US 31
Kokomo, IN 46901
Tel. 765.457.0700

Pre Qualification Credit Application

Primary Applicant Information

Last Name: First Name: MI:
Social Security Number: Birthdate:    
Address:
 City:    State:    Zip:    
Length at Address:
(yrs / mos)		 Rent/Pay:   
Prev. Address:
(if current is less
than three years)
 City:    State:    Zip:    
Length at Address:
(yrs / mos)
Employer: Job Title:
City:    State:    Zip:    
Time at Job:
(yrs / mos)		 Income:   
Home Phone:() - ex: Work Phone: () - ex:   
Alternate Phone:() - ex:
Additional Income:
(2nd job, SSI, child support, other - please specify)		 Total Additional Income:   
Previous Employer:
(if current is less than three years)		 Time at Job:
(yrs / mos)

Is this a joint application or is there a Co-borrower? Yes No

Joint or Co-borrower Information

Relationship to applicant:
Last Name: First Name: MI:
Social Security Number: Birthdate:    
Address:
 City:    State:    Zip:    
Length at Address:
(yrs / mos)		 Rent/Pay:   
Prev. Address:
(if current is less
than three years)
 City:    State:    Zip:    
Length at Address:
(yrs / mos)
Employer: Job Title:
City:    State:    Zip:    
Time at Job:
(yrs / mos)		 Income:   
Home Phone:() - ex: Work Phone: () - ex:   
Alternate Phone:() - ex:
Additional Income:
(2nd job, SSI, child support, other - please specify)		 Total Additional Income:   
Previous Employer:
(if current is less than three years)		 Time at Job:
(yrs / mos)


Comments:


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