SAMPLE CREDIT QUESTIONNAIRE


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________________________