
MEMBERSHIP CREDIT APPLICATION
Annual Fee: $3,000.00
Personal or $6,000.00 Businesses
(Instructions: Print out, complete all sections
entirely, and return by fax, email, or directmail to address below.)
Referred By:
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Applicant’s Name
(First, M.I., Last)
Co-Applicant’s Name
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Note: If Applicant and Co-Applicant have separate credit. A separate credit application should be prepared for the Co-Applicant. |
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Mailing Address – Street City State Zip
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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 |
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Previous Address (Last 3 Years) Years at Previous Address
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Number of Dependents (Not including Self) |
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Applicant’s Date of Birth |
Applicant’s Soc. Sec. No. |
Co-Applicant’s Date of Birth |
Co-Applicant’s Soc. Sec. No.
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Nearest Relative Not Living With Applicant Address City State Zip Code |
Relationship
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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 $ |
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Landlord/Mortgage Holder Account No. |
Telephone No. |
Include Taxes, Insurance, Ground Rent, Condominium Fees, Mobile Home Lot Rent, Etc. as Applicable |
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Landlord/Mortgage Holder Address |
City |
State |
Zip |
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Home Owner’s Only |
Purchase Date |
Purchase Price |
Original Mortgage |
Present Balance |
Interest Rate
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Present Value |
Property in Name(s) Of
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Other Real Estate Owned In the Name(s) Of
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Applicant’s Employer Address |
Telephone No ( ) |
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Employment Date |
Occupation |
Gross Monthly Salary
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Applicant’s Previous Employer (Last 3 Years) |
Occupation |
Length of Employment |
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Co-Applicant’s Employer Address |
Telephone No. ( ) |
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Employment Date (MM/YY) |
Occupation |
Gross Monthly Salary
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Co-Applicant’s Previous Employer (Last 3 Years) |
Occupation |
Length of Employment
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Other Income ٱ Monthly ٱ Yearly |
Source of Income |
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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. |
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Bank Name/Location – Checking Checking Account No.
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Regular
Bank Name/Location –
Savings |
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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 |
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Creditor Name/Location |
Type of Account/Collateral |
Account No. |
Monthly Pymt. |
Balance |
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Automobile Financed With |
Year/Make/Model |
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Bank Credit Card(s) – Name of Issuer |
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Total Monthly Payment and Total Balances of Open Accounts: |
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Certification & Acceptance: |
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Applicant Signature: Date: |
Return by fax with your Check payment made payable to:
ARTISTIC! CAPITAL CORP.
Or express, priority mail and/or overnight to:
ARTISTIC! CAPITAL CORP.
ATTN: MEMBERSHIP DEPT.
1940 DEER PARK AVE., STE. 254
DEER PARK, NY 11729-3328
©2003-2004 Artistic! Capital Corp.; ALL RIGHTS RESERVED.