Credit Application for LYNDEN SPORTS CENTER

Cash Down Payment:

First Name*:

Middle Name:

Last Name*:

Suffix:

Date Of Birth (MM/DD/YYYY)*:

Social Security Number/Social Insurance Number*:

Driver's Lic. No.*:

Expr. Date (MM/DD/YYYY):

State/Province*:

Marital Status*:

Number of Dependents:

Street Address*:

City*:

State*:

Postal*:

County:

Country*:

Home Phone*:

Mobile Phone:

E-Mail*:

Years at Current Address*:

Residential Status*:

Employer*:

Occupation*:

Self Employed?:

Street Address*:

City*:

State*:

Postal*:

County:

Country*:

Work Phone No.*:

Years Employed*:

Months Employed*:

Gross Income/Mo. (Pre-Tax)*:

Other Income:

Other Income Source:

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

First Name:

Middle Name:

Last Name:

Suffix:

Date Of Birth (MM/DD/YYYY):

Social Security Number/Social Insurance Number:

Driver's Lic. No.:

Expr. Date:

State/Province:

Marital Status:

Number of Dependents:

Street Address:

City:

State:

Postal:

County:

Country:

Home Phone:

Mobile Phone:

E-Mail:

Years at Current Address:

Residential Status:

Employer:

Occupation:

Self Employed?:

Street Address:

City:

State:

Postal:

County:

Country:

Work Phone No.:

Years Employed:

Months Employed:

Gross Income/Mo. (Pre-Tax):

Other Income:

Other Income Source:

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Monthly Rent or Mortgage Payment*:

Mortgage Balance:

Checking Account: YesNo

Savings Account: YesNo

Automobile Loan: YesNo

Other Loan: YesNo

Credit Card: YesNo

Has any party to this application been the subject of, or is subject to, any bankruptcy proceedings?: YesNo

Has applicant or spouse ever obtained credit under a different name?: YesNo

Have you or a spouse ever had a vehicle repossessed?: YesNo