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CREDIT APPLICATION
You must be 18 years of age in order to submit information.
TYPE OF CREDIT REQUESTED
Secured Unsecured
Individual Credit - relying on my income or assets
Individual Credit - relying on my income or assets as well as income or assets from other sources.
Joint Credit - we intend to apply for joint credit.
 
PILGRIM BANK
MEMBER FDIC
 
Date of Application
Amount
$
How Long
 
Payment Date Desired
 
Want to Repay Monthly Other
Purpose
Acct. No.
Class
SECTION A - INDIVIDUAL APPLICANT INFORMATION
Name Birth Date Tel. No. Soc. Sec. No.
Present Address City State Zip How Long
Previous Address City State Zip How Long
Email Address
Have you applied for credit with us before? No Yes - When? No. Dep. Dep. Ages
Name of Nearest Relative Not Living With You Relationship
Address Tel. No.
Employer (Company Name & Address) How Long
Bus. Tel. Position/Title How Often Paid? Gross Monthly Salary$
Previous Employer (Company Name & Address) How Long

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

Alimony, child support, separate maintenance received under:
Court Order Written Agreement Oral Understanding
Sources of Other Income Amount Per Month $
SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION
Name Birth Date Tel. No. Soc. Sec. No.
Present Address City State Zip How Long
Email Address
Relationship to Applicant (If Any)
Have you applied for credit with us before? No Yes - When?
Name of Nearest Relative Not Living With You Relationship
Address Tel. No.
Employer (Company Name & Address) How Long
Bus. Tel. Position/Title How Often Paid? Gross Monthly Salary$
Previous Employer (Company Name & Address) How Long

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

Alimony, child support, separate maintenance received under:
Court Order Written Agreement Oral Understanding
Sources of Other Income Amount Per Month $
SECTION C - MARITAL STATUS
Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state.
(*includes single, divorced and widowed)
Applicant Married Separated Unmarried *
Joint Applicant Married Separated Unmarried *
SECTION D - ASSET & DEBT INFORMATION
If Section B has been completed, this Section should be completed giving information about both the Applicant and Joint Applicant or Other Person. Please mark Applicant-related information with an "A." If Section B was not completed, only give information about the Applicant in this Section.
ASSETS OWNED (Use text area below if neccessary)
DESCRIPTION OF ASSETS
NAME IN WHICH THE ACCOUNT IS CARRIED
VALUE
  
Checking Account Number(s)
$
A
Savings Account Number(s)
$
A
Other Assets (describe)
$
A
TOTAL ASSETS
$
Asset Notes:
OUTSTANDING DEBTS (Include Charge Accounts, installment contracts, credit cards, rent,
mortgages and other obligations. Use text area below if neccessary)
CREDITOR
ACCOUNT NUMBER
NAME THE ACCT IS UNDER
ORIG. AMT
PRESENT BAL.
MO. PMTS.
 
Landlord or Mortgage Holder
Rent Payment
Mortgage
(OMIT RENT)
(OMIT RENT)


A
Automobiles (make, model, year)            
A
A
A
A
A
TOTAL DEBTS
Debt Notes:
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable):
Are you obliged to make alimony, Support or Maintenance Payments? No Yes A
If yes, to: Name Address Amount Per Month $
Are you a co maker, endorser, or guarantor on any loan or contract? No Yes A
If Yes, for whom? To whom?
Are there any unsatisfied judgments against you? No Yes A
if Yes, to whom owed? Amount $
Have you been declared bankrupt in the last 10 years? No Yes A
If Yes, where? Year ?
Other Section D Notes:
SECTION E - SECURED CREDIT
Complete only if credit is to be secured. Briefly describe the property to be given as security and indicate if others have an ownership interest.
Property Description:
Names & Addresses of all co-owners of the property:
If the security is real estate, give the full name of your spouse (if any):

By submitting this application, I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is appvoved. By submitting this application I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.