935 John St. Kalamazoo, MI 49001
Phone (269)342-1488 Fax (269)385-2089
Name of person you are co-signing for: Name: Relationship:
Property they applied for:
Please fill out the following application with your information:
Phone Number: Date of Birth:
Former Address if less then 10 years at current:
If retired please Company Name City State
See below Job Position Supervisor’s Name
Work Phone Monthly Income
Start Date Full or Part Time
Where do you Bank?
Name Branch City State
If retired please include bank account number and approximate monthly income. __________________________________-
I understand that by signing this application I agree to co-sign for only the person named above. I also understand that this application will be submitted to Credit Services Company for verification of my credit history. I have filled out ALL of the above application and did not leave any sections blank.
Signature of Co-signer: Date: