APPLICANT(S): Select one of the following options below. You may apply for individual credit in your name only, joint credit in your name and the name of your spouse, or joint credit in your name and the name of another joint applicant.
Note for residents of Wisconsin: Individual credit and joint credit may also be marital purpose debt under Wisconsin law.
Except alimony, child support and maintenance. Need not reveal income from medical insurance, disability or wage continuation insurance if applicant(s) does not choose to have such income considered as a basis for repaying this obligation.
Need not be revealed if applicant(s) does not choose to have it considered as a basis for repaying this obligation.
This is not a complete or final description of collateral.
Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Indicate by (*) those liabilities which will be satisfied or paid in full upon the granting of the extension of credit to which this application relates.