Elite Financial
Application for Secured Credit

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You must complete ALL fields
for us to make a credit decision.

Individually    Jointly Date //
P E R S O N A L   D A T A
First Name
 Middle Initial
 Last Name
 US Citizen
Yes    No
Social Security #
 Date of Birth
//		 Place of Birth
Home Address
Street City State Zip
Own   Rent Years Phone ()- Dependents
Name of Mortgage/Landlord Phone () -
Purchase Price: $ Mortgage Balance: $ Payment or Rent:$
Previous Address
Street City State Zip
Nearest Relative
Name Phone () -

E M P L O Y M E N T   D A T A
Present Employer Employer's Business
Phone Length of Employment
Street City State Zip
Position Held Salary $ Per Supervisor
Previous Employer
 Position Held
 Phone
()-		 Length of Employment
Note: Alimony, child support or separate maintenance income need not be revealed if you do not choose to rely upon it as a basis for repaying this obligation.
Other income source(s) Amount of other income:$ per

C O - A P P L I C A N T(if any)
First Name
 Middle Initial
 Last Name
 US Citizen
Yes    No
Social Security #
 Date of Birth
//		 Place of Birth
Home Address
Street City State Zip
Present Employer Employer's Business
Phone Length of Employment
Street City State Zip
Position Held Salary $ Per Supervisor
Previous Employer
 Position Held
 Phone
()-		 Length of Employment

C O L L A T E R A L   D A T A
New       Used Year Manufacturer
Model Length ID#
Fiberglass       Wood       Metal Engines:       Single       Twin     /   Gas       Diesel
Make HP
Purchase Price Before Tax: $ Sales Tax: $
Down Payment Cash: $ Trade-In:$
Amount to Finance:$ Term
Used for: Residence       Charter       Pleasure       Other
Name of Dealer/Broker Documented: Yes       No
Description of Trade Year Manufacturer
Model Length Market Value
Lienholder, if any

       


By signing below Applicant and Co-Applicant, if any, certify that: the information on both sides of this credit application and on any printed or written attachments signed or initialed by them is correct, and such information accurately represents their current financial condition. Elite Financial, or any financial institution to which it may apply for a commitment to purchase a loan made by Elite Financial, in response to this credit application, is hereby authorized to rely on the information given in this credit application, and to investigate the credit history and capacity of Applicant or Co-Applicant. In connection with this credit application, or any subsequent credit update or renewal, any proposed creditor may request a consumer report concerning the Applicant or Co-Applicant. The Applicant or Co-Applicant may ask whether the creditor obtained such a consumer report. If such a report was obtained, the Applicant or Co-Applicant may request the name and address of the consumer reporting agency which provided the consumer report to the creditor.

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information the identifies each person who opens an account.