A married person may apply for individual credit, I am applying for

			(Check one box please)

___	JOINT CREDIT with another person, Complete entire application
___	INDIVIDUAL CREDIT, Complete only individual section.
___	INDIVIDUAL CREDIT, but relying on income of another.
	Complete entire application. The other person should sign under
	section labeled "Other Person" below.

Notice to Wisconsin Applicants: YOU MUST DISCLOSE YOUR MARITAL STATUS:
married: ______ unmarried: ______ legally separated: ______

If you are a married Wisconsin applicant, you must provide your spouses
information as indicated even though your spouse may not be signing the
contract. For married Wisconsin applicant: I acknowledge that the obligation
described herein is being incurred in the interest of my marriage or family.
							    yes ____ no ____


FIRST NAME: ______________________________________
                                                     M.I. ____
LAST NAME:  ______________________________________

HOME PHONE: (   ) ________________              DATE OF BIRTH
                                             _____  _____ _____      
SOC. SEC. NO. ______ ____ ________

ADDRESS: _________________________________________ APT: _______

CITY:	 _____________________ STATE: ____ ZIP: _______________

ADDRESS SINCE?  MO. ____ YR. ____    BUY: ____ RENT: ____ OTHER: ____

PREVIOUS ADDRESS: ___________________________________________________
                   (street)         (city)        (state)      (zip)

EMPLOYER: ______________________________ SINCE: _______________

BUS. PHONE: (   ) ______________  MONTHLY GROSS SALARY $_____________

PREV. EMPLOYER: ____________ TO _______________

Income from alimony, child support or separate maintenance payments
need not be disclosed if you do not wish to have it considered as
basis for repaying this obligation.

ADD'L MONTHLY INCOME: $_________________ SOURCE: ____________________

PLEASE TELL US IF YOU HAVE:
                            CHECKING ACCOUNT? ______ (Y/N)
			    SAVINGS ACCOUNT?  ______ (Y/N)

JOINT APPLICANTS                         
FIRST NAME: ______________________________________
                                                     M.I. ____
LAST NAME:  ______________________________________

HOME PHONE: (   ) ________________              DATE OF BIRTH
                                             _____  _____ _____      
SOC. SEC. NO. ______ ____ ________

ADDRESS: _________________________________________ APT: _______

CITY:	 _____________________ STATE: ____ ZIP: _______________

DATE OF RESIDENCE: _________
                    (mm/yy)
JOINT APPLICANTS EMPLOYER: ____________________________________

BUS. PHONE: (   ) ________________

MONTHLY GROSS SALARY: $_________________ SINCE: _________
						 (mm/yy)
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU:
_________________________________________________________

RELATIONSHIP: ___________________________________________

CALL:

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