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| CAPITAL ELECTRIC COOPERATIVE, INC. | |||||||||
| ERC LOAN CREDIT APPLICATION | |||||||||
| About Yourself: | |||||||||
| First Name: | _________________ | Middle Name: | _________________ | Last Name: | ________________ | ||||
| Street Address: | _____________________________ | Own: | __________ | ||||||
| City: | _____________________________ | Rent: | __________ | ||||||
| State: | _____________________________ | Payment: | _________ | Per Month | |||||
| Zip Code: | _____________________________ | How Long: | __________________________ | ||||||
| Home Phone: | _____________________________ | If less than five years, give previous address: | |||||||
| Social Security #: | _____________________________ | Address: | __________________________ | ||||||
| Birth Date: | ____________________________ | __________________________ | |||||||
| Nearest Relative Not Living With You: | |||||||||
| Name: | _____________________________ | Relationship | _________________ | ||||||
| Street Address: | _____________________________ | Phone No.: | _________________ | ||||||
| City / State: | _____________________________ | Zip Code: | _________________ | ||||||
| About Your Work: | |||||||||
| Employer: | _____________________________ | Position: | __________________ | ||||||
| Address: | _____________________________ | Salary: | __________________ | per Month | |||||
| City / State: | _____________________________ | Phone: | __________________ | ||||||
| Zip Code: | _____________________________ | ||||||||
| Income Other Than Above: Source: | _____________________________ | Amount / Month: ______________ | |||||||
| Additional Person's Income: (Complete if Relied Upon for Repayment) | |||||||||
| First Name: | _________________ | Middle Initial: | ________ | Last Name | _____________________________ | ||||
| Social Security #: | ________________ | Birth Date: | ________ | ||||||
| Employer: | _____________________________ | Business Phone: | _____________________________ | ||||||
| Position: | _____________________________ | Salary / Month: | _____________________________ | ||||||
| Capital Electric Cooperative, Inc. | |||||||||
| Credit Application | |||||||||
| Page 2 of 2 | |||||||||
| About Your Financial References: | |||||||||
| Account With | Address | Account No. | Balance | Mon./Pymnt. | |||||
| Checking | _______________ | ____________________ | __________________ | ||||||
| Savings | _______________ | ____________________ | __________________ | ||||||
| Mortgage #1 | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Mortgage #2 | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Loan #1 | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Loan #2 | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Loan #3 | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Loan #4 | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Credit Card | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Credit Card | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Credit Card | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Credit Card | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Credit Card | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| Credit Card | _______________ | ____________________ | __________________ | _________________ | ___________ | ||||
| CREDIT INFORMATION RELEASE APPROVAL: | |||||||||
| I give Capital Electric Cooperative, Inc. the approval to request and review my credit information which can be | |||||||||
| obtained from any local credit agency. | |||||||||
| I am requesting loan funds for: | ___________________________________________________________________ | ||||||||
| Signed: | ______________________________________________ | Date: | ___________________________ | ||||||
| Signed: | ______________________________________________ | Date: | ___________________________ | ||||||