COMFORT Financial Services Credit Application

Homeowner Name (First, Middle Last) *
Social Security Number *
Date of Birth * / MM / DD YYYY
Street Address (no P.O. Boxes) *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Years at Address *
Home Phone * - (###) - ### ####
Work Phone * - (###) - ### ####
Employer *
Position (Job Title) *
Years there *
Monthly Take Home Pay * $ . Dollars Cents
Other Income (Alimony, child support or separate maintenance Incomve need not be revealed if you do not wish to have it considered as a basis for repaying this obligation) $ . Dollars Cents
Source of Additional Income
Monthly Mortgage Payment * $ . Dollars Cents
Number of Dependents (except Spouse) *
Active Bank Account in Your Name * Checking & Savings Checking Only Savings Only None
Marital Status * Married Separated Unmarried (Single, Divorced, Widowed)
Name of nearest relative not living with you * First Last
Phone # of relative * - (###) - ### ####
Relationship to that relative *
Relative Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Complete Co-Homeowner information if applying for joint credit
Co-Homeowner's Name (First, Middle, Last)
Co-Owner's Social Security Number
Co-Owner's Date of Birth / MM / DD YYYY
Co-Owner's Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Co-Owner's Work Phone - (###) - ### ####
Co-Owner's Employer
Co-Owner's Position (Job Title)
Co-Owner's Years at Employer
Co-Owner's Monthly take home pay $ . Dollars Cents

COMFORT Financial Services Credit Application

COMFORT Financial Services Credit Application

Complete Co-Homeowner information if applying for joint credit