Credit App Individual

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INDIVIDUAL PRE-APPROVAL FORM


(If you prefer to submit a hard-copy application, click here to download a PDF file.)
In the form below, all fields are required if marked * Use your tab key to move between fields.

APPLICANT INFORMATION:
Married
Unmarried
Separated
First Name: *
Last Name: *
Email Address: *
Birthdate (mm/dd/yy): *
Social Security Number: *
Driver's License Number: *
State of Issuance: *
Age of any Dependents:
CURRENT ADDRESS:
Street: *
City: *
State: *
County: *
Zip: *
Phone: *
Best Time to Contact:
PREVIOUS ADDRESS:
Street: *
City: *
State: *
Zip: *
CURRENT EMPLOYER: *
Address:
City:
State:
Zip:
Title and Occupation: *
Date of Hire (mm/yy): *
Phone:
Gross Monthly Income: *
If Retired, Date Retired:
If with current employer under 3 years, list previous employer:
Title and Occupation:
Date of Hire (mm/yy):
INCOME/BANKING:
Describe any Additional Income:
Checking Accounts: Bank and Branch
Savings Accounts: Bank and Branch
PROPERTY AND MORTGAGE INFORMATION:
1st Mortgage Holder:
Date Home Purchased (mm/yy):*
Price Paid: *
Approximate Balance Owed: *
Estimated Current Value: *
Interest Rate:
Minimum Payment: *
2nd Mortgage Holder:
Interest Rate:
Balance: *
Minimum Payment: *
Homeowner's Insurance Information:
Insurance Company:
Phone:
Optional Comments
Special Notices: You have the right to a copy of the appraisal used in connection with your application for credit. If you wish to receive a copy, please write to us at the mailing address we have provided. We must hear from you no later than 90 days after we notify you about the action taken on your credit application or you withdraw your application. A consumer report (credit report) may be requested in connection with this credit application. Upon request, you will be informed whether or not a consumer report was requested, and if a consumer report was requested, you will also be informed of the name and address of the consumer reporting agency that furnished the consumer report. If your credit request is granted, subsequent consumer reports may be obtained in connection with any updates, extension, or renewal of credit, or collection of the account. OH Accounts: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Right Commission administers compliance with the law. WI Accounts: Notice to Married Wisconsin Debtors: Unless indicated otherwise, you acknowledge this debt is for a family purpose. No marital property agreement, unilateral statement (WI Stat. Sec. 766.59), or court decree (WI Stat. 766.70) adversely affects our interest unless you know about it before credit is extended. The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
Optional Information:
I decline to furnish this information (please enter initials):
Please note: If you choose to furnish this information, please make a selection from each of the three categories below.
Gender:
Race:
Ethnicity:
This will advise you that your credit application will be submitted to a loan broker and/or lending institution or its subsidiary for purchase or consideration as to whether you meet their credit requirements. Blue Haven does not provide any direct lending or finance services. I hereby consent to and authorize Blue Haven, its brokers, and/or its lending sources to: Use this information to investigate and verify my credit record, employment and income references, and obtain other information as they may deem necessary for the purpose of obtaining a loan. 
Applicant's Permission:
Check Box: *
Enter Initials: *
Date:
By submitting this application, I: Promise that all information is true and correct for the purpose of obtaining credit; promise that I have revealed any pending lawsuits or unpaid judgments against me; intend the seller and/or assignee to rely upon these promises in deciding whether to extend credit to me; authorize a full investigation of my credit record and employment history, and authorize the seller and/or assignee to release information about my credit experience with them.
Applicant's Permission:
Check Box: *
Enter Initials: *
Date:
Address where a new pool would be built (or an existing pool remodeled):
SAME as the zip listed above in home address.
DIFFERENT than the zip listed above.
    If different, the pool site zip code is:
    If zip code is unknown, please list the city and state: