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APPLICATION FOR CREDIT

(ALL TNFORMATION GIVEN WILL BE TREATED AS STRICTLY CONFIDENTIAL)

UnitApplied for : Expected Date of Del

Term : Place of Delivery:
Total Price : Due Date:
Down Payment :

Monthly lnst, : Comm. Tax Cert. No.

Customer's Name : DoUVcl L lssued On:
lssued At:

Length of Stay : Date of Birth: tvafi,U 3 {11;

Previous Address : Place of Birth:
House/Lot : Owned \/ Free Use--
Rented [tio. Rent- Spouse Place of Birth: -irj
Name of Customer's SpouPe Date of Birth
ot l9
Name of Nearest Relative living with buyer: Present Address:
Relationship:

Name of Dependents Relationship Aoe Name of Sch. & Mo. Matriculation

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SOURCE OF INCOME:
ctrtq{Lltltt &"n'
Buyer Dtl- No,LIf Employer's Address : Dqet'
J|{4'&
Employer of
Position Occupied
:

: Monthly Salary F
Other Compensation F
W
Length of Employment :
Employer of Spouse : ,-l^ EmployerAddress :

Position Occupied : Monthly Salary F

Self-Employment : Monthly lncome F
Self-Employment of Spouse Monthly lncome P
OTHER SOURCES OF INCOME Estimate Mo. lncome F-

REAL PROPERTY AREA MARKET VALUE ENCUMBRANCES HELD BY:

PERSONAL PROPERTY MARKETVALUE ENCUMBRANCES HELD BY:

REFERENCES NOT LIVING WITH THE BUYER ADDRESS RELATIONSHIP

CommentslRemarks/Recommendation

Signature of Buyer

I Approved fl Disapproved

Approving Officer Date