CREDIT APPLICATION

Applicant Information
Name:
Date of birth:		SSN:			Phone:
Current address:
City:		State:			ZIP Code:
Own       Rent		Monthly payment or rent:				How long?
Previous address:
City:		State:			ZIP Code:
Owned  Rented		Monthly payment or rent:				How long?
Employment Information
Current employer:
Employer address:						How long?
Phone:	E-mail:				Fax:
City:		State:			ZIP Code:
Position:		Hourly Salary			Annual income:
Previous employer:
Address:						How long?
Phone:	E-mail:				Fax:
City:		State:			ZIP Code:
Position:		Hourly  Salary			Annual income:
Name of a relative not residing with you:
Address:						Phone:
City:		State:				ZIP Code:
Relationship:
Co-Applicant Information, if for a joint account
Name:
Date of birth:		SSN:			Phone:
Current address:
City:		State:			ZIP Code:
Own   Rent		Monthly payment or rent:				How long?
Previous address:
City:		State:			ZIP Code:
Owned Rented		Monthly payment or rent:				How long?
Employment Information
Current employer:
Employer address:						How long?
Phone:	E-mail:				Fax:
City:			State:		ZIP Code:
Position:			Hourly Salary		Annual income:
Previous employer:
Address:
Phone:	E-mail:				Fax:
City:			State:		ZIP Code:
Position:			Hourly Salary		Annual income:
Name of a relative not residing with you:
Address:						Phone:
City:			State:			ZIP Code:
Relationship:
Credit Cards
Name			Account no.	Current balance			Monthly payment
Mortgage Company
Account no.:			Address:
Auto Loans
Auto loans			Account no.	Balance			Monthly payment
Other Loans, Debts, or Obligations
Description			Account no.	Amount
Other Assets or Sources of Income
Description				Amount per month or value
I authorize Cycle Dragon to verify the information provided on this form as to my credit and employment history.
Signature of applicant							Date
Signature of co-applicant, if for joint account							Date