CREDIT APPLICATION


        Name:                                 Date:


        Present Address:                      No. Years:


                                              Own or Rent:

                                              No. of Dependents:


        Name and address of employer:

        Years employed in this type of work or profession:

        Years on this job:

        Position/Title:

        Type of business:

        Home phone:

        Business phone:

        Gross monthly income:

        Base employment income:

        Overtime:

        Bonuses:

        Commissions:

        Dividends/Interest:

        Net Rental Income:

        Other Sources:

        (Alimony, child support or separate maintenance income need not 
        be revealed if the Borrower does not choose to have it considered 
        as a basis for repaying this loan.)

                If employed in present position less than two years 
        state:

                Previous employer:

                Type of business:

                Position:

                Dates from/to:

                Monthly income:

                Have you declared or been declared bankruptcy in the past 
                five years?:

                Are you a party to any lawsuit?:


                     ASSETS                           DEBTS
        
        
                Checking and Savings Accounts         Loans

                Stocks and Bonds                      Notes

                                                      Credit Cards

                Real Estate Owned

                Retirement Fund

                Net Worth of Business Owned

                Automobile (make and year)

                Other


                                    ___________________________________
                                    Borrower


                                                        Form 122