Beckley's Camping Center
Credit Application..

Applicant        

Applicant's Name

(as Appears on driver's License)

Social Security #
(no dashes please)

 Driver License Number:
 		 Date of Birth:
 		Home Telephone Number:
Current Address (Street, City, State & Zip Code) Street Address MUST be shown.)
 # of
Years:
 Own:
 Rent:
 Other please explain:

 		 Monthly Payments:
$
Previous Address (Street, City, State & Zip Code) Street Address MUST be shown.)
 # of
Years
:		 Dependents:
 Age of Dependants:
Email Address of Applicant
Applicant's Employment
Employer's Name & Address
Occupation:
 Gross Monthly Income:
 $		 No. of
Years: 		Business
Telephone Number:
 Self Employed ?
Name & Address of Previous Employer
 No. of
Years:
 
Nearest Relative Not Living with you:

(Name & Address) 		Telephone Number:
 Relationship:
Have you ever had credit in another name ?
(If yes please explain:) 		Is and income listed above likely to be
reduced within the next 2 years?
Co-Applicant

Applicant's Name

(as Appears on driver's License)

Social Security #
(no dashes please)

 Driver License Number:
 		 Date of Birth:
 		Home Telephone Number:
Current Address (Street, City, State & Zip Code) Street Address MUST be shown.)
 # of
Years:
 Own:
 Rent:
 Other please explain:

 		 Monthly Payments:
$
Previous Address (Street, City, State & Zip Code) Street Address MUST be shown.)
 # of
Years
:		 Dependents:
 Age of Dependants:
Co-Applicant's Employment
Employer's Name & Address
Occupation:
 Gross Monthly Income:
 $		 No. of
Years: 		Business
Telephone Number:
 Self Employed ?
Name & Address of Previous Employer
 No. of
Years:
 
Nearest Relative Not Living with you:

(Name & Address) 		Telephone Number:
 Relationship:
Have you ever had credit in another name ?
(If yes please explain:) 		Is and income listed above likely to be
reduced within the next 2 years?
* You do not have to reveal alimony, child support or separate maintenance income unless you wish to have them considered for approving your application.
 
ASSETS -of Applicant & Co-applicant (listed on a combined basis)
Market Value DESCRIPTION (and Name In Which Held)

$		 Checking (bank name & Address)

$		 Savings

$		 Other Cash Assets: (IRA's, CD's, Stocks, Bonds, etc.)

$		 Residence:

$		 Other Real Estate (Type of Property & Address)

$		 Auto (Do not Include leased autos) give Year, Make & Model
$ Other Assets
$ < This Figure Represents MY TOTAL ASSETS
LIABILITIES -of Applicant & Co-applicant (listed on a combined basis)
Balance Owed Monthly Pmts Name & Address of Creditor Account Numbers

$
$		 Mortgage or Rent Residence:

$
$		 Other Mortgages or Loans on Real Estate:

$
$		 Personal Loans:

$
$		 1st Auto Loan:

$
$		 2nd Auto Loan:

$
$		 Other Liabilities

$
$		 Other Liabilities
  $ < This Figure Represents MY TOTAL LIABILITIES  

The following questions apply to both applicant and co-applicant.

Have you ever taken
bankruptcy?
Yes
 No
If yes, Date filed
Have you ever had
anything repossessed?
Yes
 No
If yes, Date of repossession ?
 Are there any unsatisfied Judgments against you?
Yes
 No
If yes, Amount of Judgment ?
$		    

Applicant
By clicking yes to the follow box I agree that I have answered everything truthful to the best of my knowledge.

Co-Applicant
By clicking yes to the follow box I agree that I have answered everything truthful to the best of my knowledge.



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