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102 - Master Data Work Form

The purpose of this document is to provide you with a master data worksheet to organize all the typical information that is used in applying for credit and/or loans. This document should printed out by you and only kept by you in a safe place, as the information you would list here is personal identification information including your SSN and bank account #s.


Name:    

Address:  

City/State/Zip: 

Phone:   

Fax:    

Previous Address:

City/State/Zip:     

 

How long there?     

Other Names Credit Obtained Under?

 

Date of Birth:     

Social Security Number:     

Driver’s License Number and State:


Employer’s Name:    


Employers Address:     

City/State/Zip:    

 

How Long With This Employer?     

Position Held:    

Supervisor:  

Previous Employer’s Name:  


Previous Employer’s Address:

   

Closest Relative Not Living With You:   

Address:    

City/State/Zip:     

E-mail:

Phone:   

Relationship:    

Alimony, Child Support or Maintenance Payments (only if being reported as source of income):    

 
Name of Bank:   

Bank Accounts At This Bank:     

Checking:

Other Bank Accounts:

Savings:    

Other:

Real Estate Owned/Rented:  

Name of Landlord or Mortgage Holder:   

Address:  

City/State/Zip:    
 
Phone:    

Name of Titleholder:    

Current Value:    

Mortgage Balance:    

Monthly Payment/Rent: