SAMPLE CREDIT QUESTIONNAIRE

Creditability and Reputation_________________________________
How long have you worked with him?___________________________
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______________________________________________
Remarks______________________________________________________
Signed________________________   Date________________________


Length of time known?______________________ Age______________
Single or married__________________________
Character________________ Community Reputation_______________ 
Occcupation______________ Employer's Name____________________
Employment steady?_______ Monthly Income (estimate)$_________
Amount owed you:  Due now$_______________ Past due$__________
Meeting obligations promptly?________________________________
Present Address______________________________________________
Remarks______________________________________________________
Signed_______________________    Date________________________