ADDITIONAL INCOME

Alimony, child support, separate maintenance income need not be revealed if you do not wish to have it considered as a basis for payment of the obligation.

If not at least four present Creditors, list paid out Creditor.

CO-APPLICANT INFORMATION

NOTE: LEAVE THIS AREA BLANK IF THERE'S NO CO-APPLICANT.

Each applicant (an "Applicant") herein (including any guarantor, if applicable), having first read this application, hereby executes same on the application date set forth above, and certifies, that each Applicant is of the legal age to contract and that all of the above statements are true and complete and made for the purpose of obtaining the credit hereby applied for and warrants that the above statements fully represent each Applicant's income relied upon as the basis of repayment of the credit and indebtedness herein applied for. Each Applicant hereby authorizes Creditor to communicate with each Applicant and/or any person and/or any entity in connection with and during the pendency of this application and/or any credit granted as a result thereof, for the purposes of investigation and/or verification of the references and/or statements set forth herein and any other data and/or information, written or oral, obtained by Creditor from or with respect to any Applicant herein, and/or for the purposes of extension or review or collection of any credit granted by Creditor and/or any further solicitation by Creditor to any Applicant. In addition, by signing below, APPLICANT(S) (EACH, if applicable) ACKNOWLEDGE THAT SAID APPUCANT UNDERSTANDS AND HAS BEEN INFORMED BY CREDITOR THAT THE PURCHASE OF CREDIT LIFE AND/OR CREDIT DISABILITY INSURANCE IS NOT REQUIRED BY CREDITOR TO OBTAIN ANY CREDIT FROM CREDITOR. By signing below, Applicant(s) (each, if applicable) additionally acknowledges that said Applicant understands and has been informed that Creditor must notify Applicant(s) as to the approval or rejection of this application within 30 days and that Applicant(s) can request Creditor's reasons for the action taken and Creditor will retain this application as its property whether or not this application is approved. In addition, Applicant(s), by signing below, (each is applicable), consents to Creditor providing any information it may have acquired, herein or from any other source whatsoever, with respect to said Applicant to any individual or entity, where said individual or entity represents to Creditor that the said Applicant has used Creditor, orally, or in writing, as a reference to obtain credit and/or housing and/or services and/or any product whatsoever from said individual or entity.