Financial Funders Unlimited

INSTRUCTIONS: PLEASE PRINT. COMPLETE ALL SECTIONS. IF APPLYING FOR JOINT CREDIT INCLUDE SPOUSE INFORMATION.

PERSONAL INFORMATION - AMOUNT REQUESTED $

APPLICANT'S NAME: *

SOCIAL SECURITY NUMBER: *

DAY PHONE: *

BIRTHDATE: *

MARITAL STATUS: *

DEPENDENTS? *

BANKRUPTCY? * YESNO

YEAR? *

EVENING PHONE: *

STATE/PROVIDENCE: *

ZIP CODE: *

YEARS HERE? *

EMPLOYER: *

POSITION: *

MONTHLY INCOME? *

BANK REFERENCES: *

OTHER:

PERSONAL MONTHLY INCOME & EXPENSE STATEMENT: *

INCOME FROM ALL SOURCES|PERSONAL EXPENSES DESCRIPTION: *

SPOUSE'S NAME:

SOCIAL SECURITY NUMBER:

SPOUSE'S EMPLOYER:

POSITION:

MONTHLY INCOME?

YEARS HERE?

BANK REFERENCES:

PERSONAL MONTHLY INCOME & EXPENSE STATEMENT|DESCRIPTION AMOUNT:

APPLICANT'S INCOME (FROM ABOVE): *

LOAN PAYMENT (SCHED 8): *

PAYMENTS RECEIVED ON NOTES (SCHED 2): *

NORMAL MONTHLY EXPENSES: *

MONTHLY INTEREST EARNINGS (SCHED 1): *

CREDIT CARD PAYMENTS (SCHED 10): *

MONTHLY RENTAL INCOME (SCHED 4): *

MONTHLY MORTGAGE OR RENT (SCHED 4): *

MONTHLY TAX PAYMENT (SCHED 9): *

COMISSIONS OR BONUSES: *

ALIMONY/CHILD SUPPORT PAYMENTS: *

STOCK DIVIDENDS: *

TOTAL EXPENSES: *

TOTAL INCOME: *

NET SPENDABLE INCOME MONTHLY: *

SIGNATURE(S): *