CREDIT APPLICATION

APPLICANT INFORMATION
Name:
Date of birth: Phone: Name of Spouse:
E-mail/Facebook account:
Current address:
City: Baranggay: ZIP Code:
Previous address:
City: Baranggay: ZIP Code:
Cycle of Payments: 5% monthly How long? Monthly Payments:

Name Contact Person in case of emergency: Relationship:

Contact number of the person in case of emergency:
TERM & CONDITION OF THE ITEM CREDIT
Specify the item credit: Original price Amount receive Monthly payment Current balance

I verify that information provided on this form as to my credit:

Date:

SIGNATURE OVER PRINTED NAME OF APPLICANT