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Years choose one:01 year2 years3 years4 years5 years6 years7:30:30 years8 years8 years10 years10+ years Months choose one:01 month2 months3 months4 months5 months6 months7:30:30 months8 months8 months10 months  Questionnaire *Other Monthly Income - $ Source of other income (disability, alimony, child support): *Bank Name Account Type CheckingsSavingsCheckings & Savings Education choose one:High SchoolSome College2 Yr Degree4 Yr DegreeMore than 4 Yr     Have you ever filed for bankruptcy? choose one:yesnoyes-discharged If yes, when *Have you ever had a car or other merchandise repossessed? choose one:01 year2 years3 years4 years5 years6 years7:30:30 years8 years8 years10 years10+ years If yes, when  Personal References *Personal Reference     *Address City and State Phone Relationship Personal Reference     Address City and State Phone choose one:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Relationship I certify that the information provided by me is correct. 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