CREDIT APPLICATION

 

                                                                                                                                                                

3400 NW 46 St.
Miami, FL 33142
Ph: (305) 636-2717
Fax: (305) 636-2794

Amount of Loan Requested: _____________________    Purpose Loan: ____________________________________________________                 

  ____ Individual ____ Joint ____ Co-Signer ____ Business     Has either applicant ever been ____ Bankrupt ____ Sued ____Wages Garnished   

 If yes, Who? ____________________________________  When? _________________________________

Primary Applicant

First Name:____________________  Initial:_____  Last Name: ___________________  D.O.B:_____/_____/_____  S.S.N.:_______________________

Street Address:__________________________________________________________  City/State/Zip:________________/________________/________

At Present Address: ____Years  ____Months  ____Own  ____Rent  ____Live with Parents  ____Other

Previous Street Address:___________________________________________________  City/State/Zip:________________/________________/________

Employment

Current Employer:__________________________________  Phone Number:_____________________ 

Time Employed: ____Years  _____Months                Gross Monthly Wages:_____________________

References

1.) Name:___________________________________ Phone Number: ______________________ Years Known:________

     Address:__________________________________________________________________________ Relationship:_____________

2.)Name:___________________________________ Phone Number: ______________________ Years Known:________

     Address:__________________________________________________________________________ Relationship:_____________

3.)Name:___________________________________ Phone Number: ______________________ Years Known:________

     Address:__________________________________________________________________________ Relationship:_____________

Secondary Applicant

First Name:____________________  Initial:_____  Last Name: ___________________  D.O.B:_____/_____/_____  S.S.N.:_______________________

Street Address:__________________________________________________________  City/State/Zip:________________/________________/________

At Present Address: ____Years  ____Months  ____Own  ____Rent  ____Live with Parents  ____Other

Previous Street Address:___________________________________________________  City/State/Zip:________________/________________/________

Employment

Current Employer:__________________________________  Phone Number:_____________________ 

Time Employed: ____Years  _____Months                Gross Monthly Wages:_____________________

References

1.) Name:___________________________________ Phone Number: ______________________ Years Known:________

     Address:__________________________________________________________________________ Relationship:_____________

2.)Name:___________________________________ Phone Number: ______________________ Years Known:________

     Address:__________________________________________________________________________ Relationship:_____________

3.)Name:___________________________________ Phone Number: ______________________ Years Known:________

     Address:__________________________________________________________________________ Relationship:_____________

 

Your Account Information
         Type of Account

Institution's Full Name - Address/City/State/Zip
Checking  
Savings, IMMA/CD`s/IRA  
Auto Loan  
Name of Firs Mortgage Holder or Landlord  
The above statements are submitted for the purpose of obtaining credit and are certified to be true, complete and correct.  Applicant's) expressly authorize Bank to make inquiries of other concerning the foregoing information, including, but not limited to, procuring consumer reports from consumer reports from consumer reporting agencies and to provide information arising out of Applicant's) transaction with bank to others. Any person named herein is expressly authorized to furnish Bank with information in connection with this application.  This application shall remain Banks property.  Unless I/we Initial here, Wachovia affiliates are authorized to receive the credit information provided in this application and/or by third parties so that this affiliates may extend the best possible service.  Applicant's)  __________  Referral:  Unless I/we Initial here, Bank is herby authorized to share this application and related information with Wachovia personal Loans, In which may consider my application for loan approval/purchase. Loan products may vary.  Applicant's) Initials:__________

Primary Applicant Signature:__________________________________  Date: ____/____/________