Eagle Windows & Siding

Applicant: CHECK ONE OF THE FOLLOWING BOXES. YOU MAY APPLY FOR SEPARATE OR JOINT CREDIT.		Application for:
Separate Credit	Complete applicant column and sign below.	Unsecured credit
Joint Credit with Spouse	Complete both Applicant and Spouse Sections. Both Applicant and Spouse must sign below.	Secured credit
Joint Credit with	who is not your spouse. Each of you must complete a separate application as if applying for separate credit and submit them together.

APPLICANT	MARRIED LEGALLY SEPARATED UNMARRIED
PLEASE PRINT NAME - LAST	FIRST	MIDDLE INITIAL	DATE OF BIRTH

CURRENT STREET ADDRESS

HOW LONG?

CITY / STATE / ZIP

PREVIOUS STREET ADDRESS

HOW LONG?

CITY / STATE / ZIP

COUNTY

SOCIAL SECURITY NUMBER - -

HOME PHONE NUMBER - -

CURRENT EMPLOYER

CLOCK NUMBER

HOW LONG?

EMPLOYER ADDRESS

BUS. PHONE - -

CITY / STATE / ZIP

POSITION

ANNUAL PAY. SALARY: GROSS $ NET $

Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

OTHER ANNUAL INCOME $ SOURCE

PREVIOUS EMPLOYER ADDRESS/CITY/STATE/ZIP CODE
(If current employment less than two years)

HOW LONG?

NEAREST RELATIVE NOT LIVING WITH YOU

PHONE - -

RELATIVE'S ADDRESS / CITY / STATE / ZIP

WHAT OTHER NAMES HAVE YOU PREVIOUSLY BEEN EXTENDED CREDIT?

HAVE YOU EVER BEEN SUED FOR DEBT?
Yes No

EVER BEEN A DEBTOR IN BANKRUPTCY?
Yes No

PLEASE EXPLAIN IF YOU ANSWERED YES TO EITHER OF THE LAST TWO QUESTIONS:

SPOUSE
PLEASE PRINT NAME - LAST	FIRST	MIDDLE INITIAL	DATE OF BIRTH

CURRENT STREET ADDRESS

HOW LONG?

CITY / STATE / ZIP

PREVIOUS STREET ADDRESS

HOW LONG?

CITY / STATE / ZIP

COUNTY

SOCIAL SECURITY NUMBER - -

HOME PHONE NUMBER - -

CURRENT EMPLOYER

CLOCK NUMBER

HOW LONG?

EMPLOYER ADDRESS

BUS. PHONE - -

CITY / STATE / ZIP

POSITION

ANNUAL PAY. SALARY: GROSS $ NET $

Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

OTHER ANNUAL INCOME $ SOURCE

PREVIOUS EMPLOYER ADDRESS/CITY/STATE/ZIP CODE
(If current employment less than two years)

HOW LONG?

NEAREST RELATIVE NOT LIVING WITH YOU

PHONE - -

RELATIVE'S ADDRESS / CITY / STATE / ZIP

WHAT OTHER NAMES HAVE YOU PREVIOUSLY BEEN EXTENDED CREDIT?

HAVE YOU EVER BEEN SUED FOR DEBT?
Yes No

EVER BEEN A DEBTOR IN BANKRUPTCY?
Yes No

PLEASE EXPLAIN IF YOU ANSWERED YES TO EITHER OF THE LAST TWO QUESTIONS:

CREDIT REFERENCES ( List all open accounts and any closed accounts that you want considered.)

ACCOUNT NUMBER	FINANCIAL INSTITUTION WHERE ACCOUNT IS HELD	ADDRESS/CITY/STATE/ZIP OF FINANCIAL INSTITUTION	ACCOUNT BALANCE
CHECKING			$
SAVINGS			$

MORTGAGE HOLDER OR LANDLORD NAME - ADDRESS/CITY/STATE/ZIP	PURCHASE PRICE	APPROXIMATE VALUE	BALANCE OWED	MONTHLY MORTGAGE OR RENT

AUTO MAKE - MODEL	YEAR	FINANCED BY/ADDRESS/CITY/STATE/ZIP	PURCHASE PRICE	BALANCE OWED	MONTHLY PAYMENT

OTHER INSTALLMENT LOANS	ACCOUNT NUMBER	FINANCED BY/ADDRESS/CITY/STATE/ZIP	PURCHASE PRICE	BALANCE OWED	MONTHLY PAYMENT

1. VISA #	2. MASTERCARD #	CREDIT LIMIT	BALANCE OWED	MONTHLY PAYMENT
		1 2	1 2	1 2

STORE, COMPANY, CREDIT UNION	ACCOUNT NUMBER	ADDRESS/CITY/STATE/ZIP	CREDIT LIMIT	BALANCE OWED	MONTHLY PAYMENT

OBLIGATION FOR CHILD SUPPORT, ALIMONY PAYMENTS (SPECIFY)	MONTHLY PAYMENT

For the purpose of obtaining the credit descripted above, and any future credit grated to the undersigned by the creditor named above, the undersigned, jointly and severally, represent that the above statements are true and complete, and authorize the credit named above, or its agents, to verify them and obtain additional information concerning our credit standing and furnish the same to others, and agree to the provisions of any rules, regulations or agreements of the creditor named above governing such credit. This applications is creditor's property.

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the lener's compliance with equal credit opportunity and fair housing laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish it, under federal regulations this lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below. Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.

Borrower

RACE / NATIONAL ORIGIN:
American Indian/Alaskan Native
Asian / Pacific Islander
Black Hispanic White
SEX:
Female Male
I do not wish to furnish this information.

Co-Borrower

RACE / NATIONAL ORIGIN:
American Indian/Alaskan Native
Asian / Pacific Islander
Black Hispanic White
SEX:
Female Male
I do not wish to furnish this information.