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Credit Application Form
When a client would like to establish an account with a line of credit please have them fill this Credit Application Form out and process it immediately. Inform the client that we will get back to them as soon as possible regarding their Credit Application. Verify with the applicant that the application is complete and accurate.

Free Sample Template
Format: Word PDF
# of Pages: 3
Printable: Yes

Credit Application Form TemplateForm 1300
Format: Word PDF
Category: Business, Credit
Type: Application
Credit Application Form



Applicant Information:

Application #:__________

Name: ________________________________________________________________________________________

DOB: ___/___/_____ SSN #: ______________________________ Number of Dependents: ____________________

Street Address: _________________________________________________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

How long have you resided at this address: _________ Phone Number: ___________________________________

Residential Status: _____________________________ Monthly Rent / Mortgage Payment: $__________________

Landlord Or Mortgage Holder’s Name: ______________________________________________________________

If less than two years at current address. Previous Address: _____________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

Current Employer’s Name: _______________________________________________________________________

Current Employer’s Address: ______________________________________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

Gross Monthly Salary: $__________________________ Work Phone Number: _____________________________

Occupation Title: _______________________________ Length of time: ___________________________________

If less than two years at current employer.

Previous Employer: _____________________________________________________________________________

Previous Employer’s Address: _____________________________________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

Gross Monthly Salary: $__________________________ Work Phone Number: _____________________________

Occupation Title: _______________________________ Length of time: ___________________________________

Other Income: Alimony, child support, or separate maintenance incomes do not have to be revealed

unless the credit applicant wishes to have such sources considered as a basis for this

credit application.

Gross monthly other income: $____________________ Other Income Source: $____________________________

Reference #1) __________________________________ Phone Number: __________________________________

Reference #2) __________________________________ Phone Number: __________________________________



Joint Applicant Information:

Name: ________________________________________________________________________________________

DOB: ___/___/_____ SSN #: ______________________________ Number of Dependents: ____________________

Street Address: _________________________________________________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

How long have you resided at this address: _________ Phone Number: ___________________________________

Residential Status: _____________________________ Monthly Rent / Mortgage Payment: $__________________

Landlord Or Mortgage Holder’s Name: ______________________________________________________________

If less than two years at current address. Previous Address: _____________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

Current Employer’s Name: _______________________________________________________________________

Current Employer’s Address: ______________________________________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

Gross Monthly Salary: $__________________________ Work Phone Number: _____________________________

Occupation Title: _______________________________ Length of time: ___________________________________

If less than two years at current employer.

Previous Employer: _____________________________________________________________________________

Previous Employer’s Address: _____________________________________________________________________

City: _________________________________________ State: ____________ Zip Code: ______________________

Gross Monthly Salary: $__________________________ Work Phone Number: _____________________________

Occupation Title: _______________________________ Length of time: ___________________________________

Other Income: Alimony, child support, or separate maintenance incomes do not have to be revealed

unless the credit applicant wishes to have such sources considered as a basis for this

credit application.

Gross monthly other income: $____________________ Other Income Source: $____________________________

Reference #1) __________________________________ Phone Number: __________________________________

Reference #2) __________________________________ Phone Number: __________________________________



Fair Credit Reporting Act to the Consumer


The undersigned hereby authorizes financial institutions and their affiliates to obtain information that they may require in order to verify information relative to this request including contacting spouses to verify spousal related information.

I certify that all the information given by me on this application is complete and accurate. I give my permission for any financial institution which will review this credit application to investigate my credit and employment history and to answer questions about their credit experience with me including but not limited to late payments, missed payments or other defaults and this information may be reported in the credit report.


Applicant Signature: ___________________________________________________________ Date: ___/___/_____


Applicant’s Driver’s License Number: _____________________________________________State:_____________


Joint Applicant Signature: ______________________________________________________ Date: ___/___/_____


Joint Applicant’s Driver’s License Number: _________________________________________State:_____________