Employer Name: Occupation: Employment Status: Choose One W2-Employed 1099/Self-Employed Fixed Income/Retired Homemaker Student Military Unemployed Best time to Contact: Morning (9:00-12:00) Afternoon (12:00-5:00) Evening (5:00-9:00) Time at Job: Choose One 1-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years Work/Day Number: - - Time at Residence: Choose One 1-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years Do you Rent or Own: : Choose One Rent Own Other Monthly Income: (before tax) Choose One $1250-$1500 $1501-$1750 $1751-$2000 $2001-$2250 $2251-$2500 $2501-$2750 $2751-$3000 $3001-$3250 $3251-$3500 $3501-$3750 $3751-$4000 More Than $4000 Monthly Rent/Mort.: $ .00 Date of Birth: (mm/dd/yyyy): Social Security #: - - Declared bankruptcy in the last 7 years? Choose: Yes No Is there a cosigner available? Choose: Yes No