Welcome Home Centers, Inc.
Homes On Sale


Credit Application

Application Information
First Name Middle Initial Last Name
Date of Birth Soc. Sec. Number Marital Status
Married: Unmarried: Separated:
Number of Dependent Children:  Ages:
Present Address
City, State, Zip
Home Phone Homeowner:    Renter:    Live with Relative:    Other:
Number of Years at Present Address:  Months:
Name of Nearest Relative Not Living with you: Relationship:
City, State, Zip: Phone Number:
Applicant Employment

Employer:

 City, State:
Phone Number: Job Title: Hire Date:
Gross Salary:    
  Per:  Hour:Week:Month:Year:  
Previous Employer: City & State:
Phone Number: Employed (mo/yr)
From: to:
Applicant's Other Income
Note: Alimony, Child support, or separate maintenance income need not be revealed unless you want them considered as a basis for repaying this obligation.
Source: Monthly Amount:
Applicant's Credit Information
Checking Account Account Number
Savings Account Account Number
Landlord or Mortgage Holder Name Telephone Account Number
Current Balance Monthly Payment  
 
Largest Other Obligation Telephone Account Number
Current Balance Monthly Payment  
 
Other Obligation Telephone Account Number
Current Balance Monthly Payment  
 
Other Obligation Telephone Account Number
Current Balance Monthly Payment  
 
Other Obligation Telephone Account Number
Current Balance Monthly Payment  
 
Other Obligation Telephone Account Number
Current Balance Monthly Payment  
 
Co-Applicant Information
First Name Middle Initial Last Name
Date of Birth Soc. Sec. Number Marital Status
Married: Unmarried: Separated:
Number of Dependent Children:  Ages: 
     
Present Address
City, State, Zip
Home Phone Homeowner:    Renter:    Live with Relative:    Other:
Number of Years at Present Address:  Months:
Monthly Payment  
 
Name of Nearest Relative Not Living with you: Relationship:
City, State, Zip: Phone Number:
 
Previous Street Address		  
 
 
City, State, Zip: Time at this Address
Number of Years: Months:
   
Name of Nearest Relative NOT living with you Relationship:
City, State, Zip: Phone Number:
Co-Applicant Employment
Employer: City, State:
Phone Number: Job Title: Hire Date:
Gross Salary:    
  Per:  Hour:Week:Month:Year:  
Previous Employer: City & State:
Phone Number: Employed (mo/yr)
From: to:
Co-Applicant's Other Income
Note: Alimony, Child support, or separate maintenance income need not be revealed unless you want them considered as a basis for repaying this obligation.
Source: Monthly Amount:
Fair Credit Reporting Act Notice to Consumer
This will advise you that your retail installment contract and credit application will be submitted to West Valley View Inc., for purchase and consideration as to whether you meet their credit requirements.

Notice: To New York Residents. West Valley View Inc., may obtain a consumer report on you in connection with your credit application. Upon request by you, West Valley View Inc., will tell you whether or not a consumer report was obtained and the name and address of the consumer reporting agency that furnished the report.

I hereby declare that all of the statements made in this application are true and correct and are made for the purpose of obtaining credit. You are authorized to investigate my credit record, to verify credit, employment and income references, to obtain such other information as West Valley deems necessary, and to give credit reporting agencies (credit bureaus) and others information regarding your credit experience with me.