B & L Marine - Finance Form

General Information

Will you be applying for Individual or Joint Credit

If applying for joint credit, please sign below to verify that you intend to apply for joint credit

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Marital Status: Complete marital status if this loan is for: a. Joint or secured credit, or b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)

Primary Applicant

Name
Date of Birth
Home Address
Residence Type
Previous Address
Residence Type
Employment Status
Job Start Date
Per

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.

Per
Previous Employment Status
Previous Job Start Date
Previous Job End Date
Per

Co-Applicant

Name
Date of Birth
Home Address
Residence Type
Previous Address
Residence Type
Employment Status
Job Start Date
Per

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.

Per
Previous Employment Status
Previous Job Start Date
Previous Job End Date
Per

References

Nearest Relative Not Living With You

Name
Address

Debts/Monthly Payments

List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan.

Additional Information

How would you prefer to be contacted?

Signatures

Income verification is required; other information may be required.
I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)

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Date
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Date
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