Credit Application

C R ED I T A P P L I C A T I O N

Part I IMPORTANT: Lender/Must Complete Part I Before Applicant Completes Application

{___} Individual Account- Secured {___}Authorized user

{___} Individual account- unsecured {___}Individual Account

{___} Joint account {___}Relying on Income of Spouse or other person

Date:

Amount Requested

Term

Payment Date Desired

Proceeds of Loan to be Used for:

Part II Applicant Instructions PERSONAL Part II must be completely filled in expect for shaded areas which are optional

Title { }Ms { } Miss

Optional { }Mr { } Mrs

Name Last First Middle

No. of Dep

Date of Birth

Address No. & Street City County State zip code	years	social security no.
Address No. & Street City County State zip code	years	Residence Phone

Are you a U.S. If no Describe Immigration Status Do not complete if this application { } Married { } Separated

Citizen? is for individual unsecured Credit. { } Unmarried (inc. single, divorced, widowed)

{ }yes { }No

YOUR JOB Present Employer Position No. Years There	Wages { } Weekly $ { } Bi-Weekly { } Monthly
Address No. & Street City State Zip Code	Business Phone

Former Employer (if less than 3 Years) Address

Optional Alimony or child support or separate maintenance payments are optional information and Verification Required { } Monthly

Income need not be revealed if the applicant does not choose to rely on such income in a applying for credit { } Quarterly { } Annually

$ Source { } Semi-Annually

ADDITIONAL INCOME	SOURCE
FINANCIAL	SAVINGS BRANCH

DEBTS-LIST ALL BANKS, STORES, LOAN & FINANCE COMPANIES, CREDIT UNIONS AND OTHERS TO WHOM YOU ARE INDEBTED. INCLUDE ANY REVOLVING LINE OF CREDIT

USE EXTRA SHEET MONTHLY PRESENT MONTHLY PRESENT

IF NECESSARY CREDITOR PAYMENT BALANCE CREDITOR PAYMENT BALANCE

1.- Landlord or { } Rent Mortgage Holder { } Own			4
2.-Auto-Lienholder			5
3			6

Other No. of Dependents and ages obligations	total monthly liability to pay alimony child support or separate maintenance $
Credit References	3
2	4

Previous I Have received credit in the past Name Creditor Year

Credit while using the following Name

Are you a CO-MAKER, Endorser or If "YES" To whom?

Guarantor on any loan or contract? YES { } NO { } For Whom?

Are there any unsatisfied

judgments against you?

Where you

ever Bankrupt?

Name of nearest relative or fiend not living with you

Description of property securing credit (if Applicable)

PART III CO-APPLICANT/USER: PERSONAL To Be Checked by Lender.

{ } joint Account { } Authorized user { } Individual account (Relying on income of Spouse or other person)

Co-Applicant/User Instructions Must Be Completely Filled-In

Title { }Ms { } Miss

Optional { }Mr { } Mrs

Name Last First Middle

No. of Dep

Date of Birth

Address No. & Street City County State zip code	years	social security no.
Address No. & Street City County State zip code	years	Residence Phone

Are you a U.S. If no Describe Immigration Status Do not complete if this application { } Married { } Separated

Citizen? is for individual unsecured Credit. { } Unmarried (inc. single, divorced, widowed)

{ }yes { }No

YOUR JOB Present Employer Position No. Years There	Wages { } Weekly $ { } Bi-Weekly { } Monthly
Address No. & Street City State Zip Code	Business Phone

Former Employer (if less than 3 Years) Address

Optional Alimony or child support or separate maintenance payments are optional information and Verification Required { } Monthly

Income need not be revealed if the applicant does not choose to rely on such income in a applying for credit { } Quarterly { } Annually

$ Source { } Semi-Annually

ADDITIONAL INCOME	SOURCE
FINANCIAL	SAVINGS BRANCH

DEBTS-LIST ALL BANKS, STORES, LOAN & FINANCE COMPANIES, CREDIT UNIONS AND OTHERS TO WHOM YOU ARE INDEBTED. INCLUDE ANY REVOLVING LINE OF CREDIT

USE EXTRA SHEET MONTHLY PRESENT MONTHLY PRESENT

IF NECESSARY CREDITOR PAYMENT BALANCE CREDITOR PAYMENT BALANCE

1.-Landlord or { } Rent Mortgage Holder { } Own			4
2.-Auto-Lienholder			5
3			6

Other No. of Dependents and ages obligations	total monthly liability to pay alimony child support or separate maintenance $
Credit References	3
2	4

Previous I Have received credit in the past Name Creditor Year

Credit while using the following Name

Are you a CO-MAKER, Endorser or If "YES" To whom?

Guarantor on any loan or contract? YES { } NO { } For Whom?

Are there any unsatisfied

judgments against you?

Where you

ever Bankrupt?

CREDIT INQUIRIES

I/WE AUTHORIZE The Lender to make whatever credit inquiries it deems necessary in connection with this credit application or in the course of review or collection of any credit extended in reliance on the application. I/We authorize and instruct any person or consumer reporting agency to compile and furnish to the Lender any information it may have or obtain in response to such credit inquiries and agree that same shall remain your property whether or not credit is extended.

I am/We are hereby notified that a consumer report may be requested in connection with this credit application. If I/we request, I/we will be informed whether or not a consumer report was requested, and if such report was requested, I/We will be informed of the name and address of the consumer reporting agency that furnished the report. Subsequent consumer reports may be requested or utilized in connection with an update, renewal or extension of the credit. All information set forth in this application is declared to be a true representation of facts for the purpose of obtaining the credit requested and any willful misrepresentation on this application could result in criminal action.

_________________________________ _________________ _________________________________________ ___________________

co-applicant/user signature date Applicant's Signature date