___________________________ _________________ _________________ _________________
________________________________________________________________ _______________________________ ___________________
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CREDIT LINE ACCOUNT
AND PERSONAL LOAN APPLICATION
1325 Oxford Drive Allentown, PA 18103
(610) 791-2376 FAX (610) 791-2900
$
$
$
$
$
$
$
$
$
$
ACCOUNT NUMBER - APPLICANT ACCOUNT NUMBER - CO-APPLICANT DATE
Applicant Information
PRINT OR TYPE ALL INFORMATION
1. If You live in a community property state, are You:
Married Separated Unmarried (Includes Single, Divorced and Widowed)
2. Married applicants can apply for an individual loan. Indicate if You want an:
Individual Loan Joint Loan with Your Spouse/Co-Applicant
3. Method of Payment:
Payroll Deduction Automatic Share Transfer Cash Payment
4. Frequency of Payment: Weekly Bi-Weekly Semi-Monthly Monthly
Spouse/Co-Applicant Information
5. Complete Spouse/Co-Applicant Information only if:
a. This is for a joint account with Your Spouse or other Co-Applicant.
b. Your Spouse will use Your Account.
c.
You are relying on Your Spouse's income as a source of repayment for the credit requested.
d. You live in a community property state Arizona, California, Idaho, Louisiana,
Nevada, New Mexico, Texas, Washington, Wisconsin (and Puerto Rico).
6. Definitions:
Whenever used in this application the words You and Your refer to the Applicant(s)
or Spouse/Co-Applicant and the words We, Us, and Our refer to the Lender.
Credit Applied For:
Type of credit Amount Requested $ Refinanced Amount $ Total Request $
Purpose Collateral Offered Value $
There are costs associated with the use of any Credit Card issued to You by Us. You may request specific information about these
costs by contacting Us by telephone at (610) 791-2376 (callers from outside the 610 area code may call collect), or by writing to
Us at 1325 Oxford Drive, Allentown, PA 18103.
APPLICANT OR CO-SIGNER
own; rent; live with other
FIRST NAME INITIAL
LAST NAME
SOCIAL SECURITY NUMBER
BIRTHDATE
CURRENT STREET ADDRESS
APT.
SINCE (MO. YR.)
CITY
STATE
ZIP
COUNTY
EMAIL ADDRESS
FORMER ADDRESS (COMPLETE IF PREVIOUS ADDRESS IS LESS THAN 3 YEARS) YEARS THERE
CELL PHONE
HOME PHONE
NO. OF DEPS
AGES OF DEPENDENTS
NAME, ADDRESS AND PHONE NUM BER OF NEAREST RELATIVE NOT LIVING WITH YOU
EMPLOYMENT AND INCOME If self-employed or retired, attach financial statement or income tax returns.
CURRENT EMPLOYER (INCLUDE EMPLOYEE I.D. IF APPLICABLE)
EMPLOYMENT DATE
ADDRESS/CI TY/STATE/ZIP
WORK PHONE
POSITION
MO. GROSS INCOME
$
FORMER EMPLOYER
POSITION
YEARS
OTHER INCOME You need not list income from alimony, child support, or separate maintenance payments unless You want it considered in evaluating this credit application.
TYPE OF OTHER INCOME
MONTHLY AMOUNT
$
NAME AND ADDRESS OF PAYER
ASSETS AND DEPOSITS Attach a separate sheet if necessary.
TYPE
BANK (OR OTHER) NAME, ADDRESS
AC
COUNT NO.
APPROX. BAL.
VALUE
$
VALUE
$
HOMEOWNERS: PLEASE INDICATE NAME(S) ON DEED
PURCHASE PRICE
APPROX. VALUE
SPOUSE/CO-APPLICANT
own; rent; live with other
FIRST NAME INITIAL LAST NAME
SOCIAL SECURITY NUMBER
BIRTHDATE
CURRENT STREET ADDRESS
APT.
SINCE (MO. YR.)
CITY STATE
ZIP
COUNTY
EMAIL ADDRESS
FORMER ADDRESS (COMPLETE IF PREVIOUS ADDRESS IS LESS THAN 3 YEARS) YEARS THERE
CELL PHONE
HOME PHONE
NO. OF DEPS
AGES OF DEPENDENTS
NAME, ADDRESS AND TELEPHONE OF NEAREST RELATI VE NOT LIVING WITH YOU
CURRENT EMPLOYER (INCLUDE EMPLOYEE I.D. IF APPLICABLE)
EMPLOYMENT DATE
ADDRESS/CITY/STATE/ZIP
WORK PHONE
POSITION
MO. GROSS INCOME
FORMER EMPLOYER
POSITION
YEARS
TYPE OF OTHER INCOME
MONTHLY AMOUNT
NAME AND ADDRESS OF PAYER
TYPE
BANK (OR O
THER) NAME, ADDRESS
ACCOUNT NO.
APPROX. B
AL.
VA
LUE
$
VALUE
$
HOMEOWNERS: PLEASE INDICATE NAM E (S) ON DEED
PURCHASE PRICE
$
APPROX. VALUE
$
Copyright Oak Tree Business Systems, Inc., 1998-2015. All Rights Reserved.
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