Creditability and Reputation Reference_________________________________ How long have you worked with Reference?___________________________ Highest credit on: Charge account___________________________ Highest credit on: Installment credit_______________________ Present amount owed: Due now________________________________ Present amount owed: Past due_______________________________ Meeting obligations promptly?________________________________ Present Address______________________________________________ Length of time at this address?______________________ Age______________ Single or married__________________________ Occcupation______________ Employer's Name____________________ Employment steady?_______ Monthly Income (estimate)$_________ Past Address(if they moved in last 2 years)______________________________________________ Remarks______________________________________________________ Signed_______________________ Date________________________
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