Credit Application

* = Required Field

Type of Credit Requested Secured Unsecured

Check the appropriate box below: Individual Credit - relying solely on my income or assets Joint Credit - We intend to apply for joint credit

Amount Requested*

Purpose*

Applicant

First Name*

Middle Initial

Last Name*

Social Security #*

Drivers License #

Expiration Date

Issued Date

Issued By

Primary Phone*

Home Phone

Work Phone

Cell Phone

Email Address*

Date of Birth*

Best Time to Contact

Method of Contact*

Current Physical Address

Address Line 1*

Address Line 2

Zip*

City*

State*

My mailing address is different than my address line 1 Mailing Address

Employment Information

Current Employer / Source of Income*

Occupation

Years at Current Employer

Years Employed in this Profession

Primary Gross Income (annually)*

Secured Credit

Briefly describe the item to be given as security:

Property Description: Names and Addresses of all co-owners of the property:

Notice to married applicants: No provision of any marital property agreement, unilateral statement under Wisc. Statues §766.59 or a court decree under Wisc. Statues §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By checking the box below, I authorize Lender to check my credit and employment history. I understand that I must update credit information at Lender's request if my financial condition changes.

I have read and agree to the terms

Date*

We certify that everything we have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By checking the box below, we authorize Lender to check our credit and employment history. We understand that we must update credit information at Lender's request if our financial condition changes.

We have read and agree to the terms*

Today's Date*

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