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APPLICANT: |
First Name*:
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Last Name*:
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# In Family*:
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US Citizen*:
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Date Of Birth*:
,
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Marital Status*:
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SSN*: (ex: 123121234)
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Drivers Lic
#*:
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Email*:
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| Current Address: |
Street Number:
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City*:
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State*:
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Zip*:
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Time Yr/Mths at Current Address:
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Rent or Own:
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Monthly Pymt:
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If you have been at current address less
than 3 years, please provide the following: |
| Previous Address: |
Street Number:
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City:
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State:
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Zip:
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Time Yr/Mths at Previous Address:
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Rent or Own:
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Monthly Pymt:
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Daytime Phone Number:
(ex: 123-123-1234)
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Evening Phone Number:
(ex: 123-123-1234)
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Employers
Name*:
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Years Employed:
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| Employers
Address: |
Street Number:
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City:
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State:
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Zip:
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Employer's Phone Number:
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Your Occupation/Title:
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Monthly
Income: $ |
Other Monthly Income
(From Rentals, Social Security, etc.)
$
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Source of Other Income
(ex: Rentals, Social Security)
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Total Gross
Monthly
Income:
$ |
| If you have been at current employer less
than 3 years, please provide the following: |
Previous Employers
Name*:
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Years Employed:
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| Previous Employers
Address: |
Street Number:
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City:
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State:
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Zip:
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Previous Employer's Phone Number:
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Your Previous Occupation/Title:
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Nearest
Relative Not Living With You:
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Relation:
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Street Number:
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City:
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State:
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Zip:
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Relative's Phone Number:
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| AGREEMENT: |
| By submitting this form, applicant(s) understands that a credit report may be requested. Sterling Associates or Pedata Resales, Inc. may then show up under inquiries on your credit report in the future. Applicant(s) certifies that the above information is true and complete as of this date. Agrees that this application is the property of the bank and need not be returned to the applicant(s). Authorizes the bank to verify the accuracy and completeness of all information shown above from any source the bank chooses, including obtaining credit bureau reports. This authorization extends to the applicant's spouse if applicant resides in a community property state. Authorizes the bank to answer questions from others about its credit experience with the applicant(s), furnish such information to credit bureaus, and share foregoing information consistent with its privacy policy. |
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