Credit Account Application Form - Free Legal Template
This document is an application form for opening a credit account. It collects personal, employment, and credit history information from an applicant, along with their preferences for the credit account. The form also includes a certification and authorization section for the applicant, and a dedicated section for the financial institution's internal use to process and track the application.
Application to Open a Credit Account
Personal Information | |
Full Name | |
Date of Birth ([mm/dd/yyyy] | ____ / ____ / ________ |
Email Address | |
Phone Number | () - |
Current Address | Street: |
Previous Address [if less than than 2 years at current address] | Street: |
Employment Information | |
Employment Status [check one]: | ( ) Employed ( ) Self-employed ( ) Unemployed ( ) Retired ( ) Student |
Current Employer [or source of income]: | |
Job Title [if applicable]: | |
Work Phone Number: | () - |
Employer's Address: | Street: |
Length of Employment: | years months |
Annual Income (before taxes): | $/£/€ |
Additional Income (if any, specify source): | |
Annual Amount: $/£/€ |
Credit History | |
Have you ever filed for bankruptcy? | ( ) Yes ( ) No |
If yes, please provide details: | |
Have you ever had a judgment or lien filed against you? | ( ) Yes ( ) No |
If yes, please provide details: |
Credit Account Preferences | |
Requested Credit Limit (optional): | $/£/€ |
Would you like to add an authorized user to the account? | ( ) Yes ( ) No |
If yes, please provide the following information about the authorized user: | Full Name: __________________________________________________________ |
Certification and Authorization
By signing below, I certify that the information provided in this application is true and complete. I authorize the financial institution to check my credit and employment history and any other necessary information to determine my creditworthiness. I understand that the financial institution may share my information with credit reporting agencies and other third parties as required by law.
Signature: | Date: |
Submitting the Application
Please review your application for accuracy before submitting. You may submit your completed application in one of the following ways:
Email a scanned copy to: [email address]
Mail to: [mail to address]
Please allow 7-10 business days for your application to be processed. You will be notified of the decision via email or phone. If you have any questions, please contact our customer service department at [PHONE NUMBER].
For Office Use Only
Application Received Date:
Reviewed By [name]:
Employee ID:
Verification
Credit Check Performed: ( ) Yes ( ) No
Date: Agency:
Credit Score: Risk Grade:
Income Verification Performed: ( ) Yes ( ) No
Method: Date:
Employment Verification Performed: ( ) Yes ( ) No
Method: Date:
Decision
Application Decision: ( ) Approved ( ) Declined
Approved Credit Limit: $
Interest Rate: % APR
Terms & Conditions Version:
Date of Decision:
Decision Notes (if any):
Notifications
Applicant Notified: ( ) Yes ( ) No
Method: Date:
Authorized User Notified [if applicable]: ( ) Yes ( ) No
Method: Date:
Account Number Assigned:
Date Account Opened:
Comments:
Note: This "For Office Use Only" section is for the internal use of the financial institution to process, review, and track the application. It should be kept separate and confidential from the applicant's submitted information.
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