Primary Applicant
|
Joint Applicant
Application is for joint credit with primary
applicant or as a guarantor
Primary applicant is relying on you for income
for alimony, child support, or separate maintenance or on your income
or assets as the basis for repayment of the credit requested |
| If Joint, Relationship
to Applicant Spouse
Parent
Other
|
| First:
Mid:
Last:
Title
|
| Driver's Li:
Soc Sec:
DOB:
|
| Street:
|
| City:
State:
Zip:
|
| Cnty:
Ph:
Home
Pay
|
| Cell Phone
Other Phone
Email
|
Mortgage Holder/Landlord
Phone:
How Long
|
Previous Address
if less than 2 years at present address
How Long
|
Level of Education
4 Yr College Grad
2 Yr College Grad
Special Training
Some College
High School Grad
Some High School
|
Employer
Address
|
| Occupation (If Military - State Rank)
Employer's Phone
|
| How Long Have You Work For Current Employer
Monthly Gross Salary:
|
Other Income Source
Source:
Amount:
|
Previous
Employer and address if less than five yrs. with current employer
|
| Name of Bank
Type Account
|
Have You Ever Had a Car or Other Merchandise Repossessed in the past 6 Years?
If So, State Month and Year
|
Have You Filed For Bankruptcy in the past 9 Years?
If So, State Month and Year
|
| CALIFORNIA RESIDENT FC 7141-04/CM
AUG 97 |
| Applicant, if married,
may apply for a separate account. |
| NEW HAMPSHIRE RESIDENT FC7141-28/CM
AUG 97 |
| I acknowledge receipt
of a true and completely filled in copy of this credit application
form at the time of signing. |
| NEW YORK RESIDENT FC 7141-31/CM
AUG 97 |
| A Consumer Report may
be requested in connection with this application for credit or
any future update, renewal, extension of such credit. Upon request,
you will be informed whether or not a consumer report was requested.
If a report was requested, you will be informed of the name and
address of the consumer agency that furnished the report. |
| TENNESSEE RESIDENT FC 7141-41/CM
AUG 97 |
| You must maintain insurance
during the term of the contract. You must give the Creditor evidence
of this insurance. The amount and type of insurance must be acceptable
to the Creditor. YOU MAYCHOOSE THE PERSON THROUGH WHOM ANY INSURANCE
IS OBTAINED. |
|
| For
the purpose of securing credit from you, I certify that the above information
is true and complete to the best of my knowledge. Applicant authorizes
you, to check my credit and employment history and to provide and/or
obtain information about credit experience with me. |
INTIAL PRIVACY NOTICE
In connection with your transaction, Charapp may obtain information
about you as described in this notice, which we handle as stated in
this notice. This does not apply to information
obtained in a non-financial transaction.
1)We collect non-public personal information about you from the following
sources:
*Information we receive from you on applications
or other forms in connection with a financial
transaction;
*Information about your transactions with us. Our
affiliates or others; and,
*Information we receive from a consumer reporting
agency.
2)We may disclose all of the information we collect, as described above,
to companies that perform marketing services or other functions on our
behalf or to other financial institutions with whom we have joint marketing
agreements. We may make such disclosures about you as a consumer, customer,
or former customer.
3)We may also disclose non-public personal information about you as a
consumer, customer, or former customer, to non-affiliated third parties
as permitted by law.
4)We restrict access to non-public personal information about you to
those employees who need to know that information to provide products
or services to you. We maintain physical, electronic, and procedural
safeguards that comply with federal regulations to guard your non-public
personal information.
CUSTOMER ACKNOWLEDGEMENT: I (we) acknowledge that I (we) received read
this notice by clicking the yes button. |
|
Permission to Check Credit:
|
|
