Applicant’s Name (First, M.I., Last)                                          Co-Applicant’s Name

Note: If Applicant and Co-Applicant have separate credit.  A separate credit application should be prepared for the Co-Applicant.

Mailing Address – Street                                                     City                                                     State                                          Zip

Move-in Date (MM/YY)

Telephone No.

(          )

Telephone in Home

ٱYes    ٱNo    ٱNearby

Telephone in Name of            Applicant:  ٱYES or NO  ٱ

 Unlisted ٱ     Listed ٱ    

Previous Address (Last 3 Years)                                                                Years at Previous Address

Number of Dependents

(Not including Self)

Applicant’s Date of Birth

Applicant’s Soc. Sec. No.

Co-Applicant’s Date of Birth

Co-Applicant’s Soc. Sec. No.

Nearest Relative Not Living With Applicant                       Address City  State Zip Code

Relationship

Housing Status

ٱ Owns/Buying     ٱ Free

ٱ Rents     ٱ With Parents

Type of Housing   ٱ Apartment   ٱ Mobile Home

ٱ House   ٱ Condominium   ٱ Room   ٱ Other:_______________

Monthly Rent/Mortgage Payment

$

Landlord/Mortgage Holder                                                       Account No.

Telephone No.

Include Taxes, Insurance, Ground Rent, Condominium

Fees, Mobile Home Lot Rent, Etc. as Applicable

Landlord/Mortgage Holder Address

City

State

Zip

  Home Owner’s

   Only

Purchase Date

Purchase Price

Original Mortgage

Present Balance

Interest Rate

Present Value

Property in Name(s) Of

Other Real Estate Owned                                                                                   In the Name(s) Of

Applicant’s Employer                                                                     Address

Telephone No

(          )

Employment Date

Occupation

Gross Monthly Salary

Applicant’s Previous Employer (Last 3 Years)

Occupation

Length of Employment

Co-Applicant’s Employer                                                             Address

Telephone No.

(          )

Employment Date (MM/YY)

Occupation

Gross Monthly Salary

Co-Applicant’s Previous Employer (Last 3 Years)

Occupation

Length of Employment

Other Income                              ٱ     Monthly                                                                   

                                              ٱ               Yearly         

Source of Income

Note: Alimony, Child Support or Separate Maintenance Income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.

Bank Name/Location – Checking               Checking Account No.  ٱ Regular         Bank Name/Location – Savings            Savings Account No.    ٱ Reg. Savings

                                                                                                                                            ٱ Now                                                                                                                                                    ٱ IRA Keogh

                                                                                                                                                                                                                                 ٱ  Other  

Open/Paid Creditors – List Open and Closed Accounts:         ▪ Bank Credit Cards             ▪ Finance Companies           ▪ Credit Unions

(Attach Second Sheet if Necessary)                                        ▪ Bank Loans                       ▪ Department Stores             ▪ Others   

Creditor Name/Location

Type of Account/Collateral

Account No.

Monthly Pymt.

Balance

Automobile Financed With

Year/Make/Model

Bank Credit Card(s) – Name of Issuer

Total Monthly Payment and Total Balances of Open Accounts:

 If a “Yes” answer is given to any of the following questions, please explain:

Have you any outstanding judgments?  In the last 7 years, have you been declared bankrupt? ……….............................................................................................

Have you had property foreclosed upon or given title or deed in lieu thereof?                             ...................................................................................………..

Are you a co-maker or endorser on a note?                                                                                      …............................................................................................……..

Are you a party in a lawsuit?                                                                                                               .……….
 

Are you obligated to pay alimony, child support, or separate maintenance?                                ………......................................................................

       Applicant

    Yes          No



    Yes          No

 

    Yes          No
 

    Yes          No


 

    Yes          No

   Co-Applicant

   Yes          No



   Yes          No

 

   Yes          No
 

   Yes          No


 

   Yes          No

Written explanation of any derogatory credit (as complete as possible, including dates.)

ACCEPTANCE & CERTIFICATION:  I/We have made an application to obtain an agent  account and/or line of  credit referring account thru Artistic! Capital Corporation’s direct lenders and affiliations for my funding clients.  I/We understand that an application fee of $375.00 and a $85.00 personal credit report fee is due.  I/We clarify that all statements made in this application are true, complete and accurate to the best of our abilities; and are made for the purpose of obtaining the particular account requested.  To knowingly make any false statements concerning any of the above information or to provide misleading, misrepresented, or falsifying information for the basis of an approval will result in My/Our application being declined, refused, and rejected.  My/Our signature confirms authorization for Artistic! Capital Corporation, its assigns and affiliates to review My/Our personal and business credit reports.  Upon my request for any credit granting service offered through Artistic! Capital Corporation, I/We agree to pay to Artistic! Capital Corporation an Agency Service Fee of Eleven Percent (11%) immediately upon receiving any credit related, financing service product, line of credit, business loan, and/or any other credit services I/We have been approved. *

Applicant’s Signature                                             Date

Co-Applicant’s Signature                                             Date

  * Additional documents will be required with signature.

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