Northland Credit

Online Consumer Credit Application
Co-Borrower

Co-Borrower other than spouse may require separate financial information

Do not complete this section unless you are applying for a joint account or an account that you another person will use, or if you are applying for an individual account but are relying on income from alimony, child support or seperate maintenance, or on the income or assets of another person as the basis for repayment of credit requested.

First Name:
Middle Initial:
Last Name:

Co-borrower's Mailing Address:
Street, PO box, etc. Apt. no.
City:
State:
Zip Code: -

Co-borrower's Residence Address
Number, Street: Apt. no.
City:
State:
Zip Code: -
Time at above address: Years, Months

Co-borrower's Former Address
Number, Street: Apt. no.
City:
State:
Zip Code: -
Time at above address: Years, Months

Social Security Number:
Home Phone Number:
Drivers Licence Number:
Date of Birth: Month/Day/Year //
Child Support Paid:
Number of dependents, including self:

Co-borrower's Name, address of nearest relative not living with you:
Name:
Address:
City, State, Zip: ,
Phone Number: ()

Co-borrower's Occupation/Income
Current Employer:
Address:
Phone Number
Length of Employment: Years, Months
Position/Grade:
Monthly net salary: $
Rotation Date:
ETS:

Former Employer:
Position:
Length of employment: Years, Months

Sources of additional income (stock, real estate, retirement, etc), income recieved from child support, alimony, or maintenance is optional information furnished only if you desire this income to be considered in evaluating your application.
Type of other income:
Source:
Monthly Amount: $

Co-borrower's Deposit Information
Type
Bank Name:
Location:
Account Number:
Approx. Balance:



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