Checkmate Lines of Credit

Personal Information

Name
OK Name is required
Social Security Number
OK Social Security Number is required
Date of Birth

OK Date of Birth is required
Phone Number
OK Phone Number is required
Email
OK Email is required
Employer's Name
OK Employer's Name is required
Length of Time Employed
OK Length of Time Employed is required
Employer's Phone Number
OK Employer's Phone Number is required

Address Information

Address
OK Address is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required

Co-Applicant Information

Will there be a Co-Applicant?
- No
- Yes
OK Will there be a Co-Applicant? is required

Co-Applicant

Name
OK Name is required
Date of Birth

OK Date of Birth is required
Social Security Number
OK Social Security Number is required
Phone Number
OK Phone Number is required
Address
OK Address is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required
Employer's Name
OK Employer's Name is required
Length of Time Employed
OK Length of Time Employed is required
Employer's Phone Number
OK Employer's Phone Number is required

Income and Residence

Applicant Gross Monthly Wages
OK Applicant Gross Monthly Wages is required
Applicant Other Income
Optional OK Applicant Other Income is required
Co-Applicant Gross Monthly Wages
OK Co-Applicant Gross Monthly Wages is required
Co-Applicant Other Income
Optional OK Co-Applicant Other Income is required

*You need not list income from alimony, child support or separate maintenance unless you wish for it to be considered

Rent or Own
- Own Home
- Rent
- Other
OK Rent or Own is required
Name of Mortgage Holder or Landlord
OK Name of Mortgage Holder or Landlord is required
Monthly Mortgage or Rent Payment
OK Monthly Mortgage or Rent Payment is required

Loan Information

Requested Loan Amount
OK Requested Loan Amount is required
Payment Date Requested
OK Payment Date Requested is required
Purpose of Credit
OK Purpose of Credit is required
Applicant Signature (Full Name)
OK Applicant Signature (Full Name) is required
Co-Applicant Signature (Full Name)
Optional OK Co-Applicant Signature (Full Name) is required
Date (MM/DD/YYYY)
OK Date (MM/DD/YYYY) is required

Security Code

OK is required

I (WE) HEREBY APPLY FOR CREDIT. All information is true, and I have not omitted any material information. I understand that this application will be retained whether or not it is approved. You are authorized to check my credit and employment history, and to answer questions about your credit experience with me.