hms2.gif (8504 bytes)           

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:

Name:                                                                                                      S.S.#:                                                                                   

Phone Number:                                                                                      Date of Birth:                                                                    

Email Address:                                                                                                                                                                                    

Current Address:                                                                                                                                 

Former Address if less then 10 years at current:  



Job Information:                                                                                                                                                
If retired please                    Company Name                                  City                        State
Provide banking
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. __________________________________-
                                                                                                                                Account Number
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: