"Credit Application Form" - New York City

Credit Application Form is a legal document that was released by the New York City Department of Finance - a government authority operating within New York City.

Form Details:

  • Released on November 22, 2011;
  • The latest edition currently provided by the New York City Department of Finance;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York City Department of Finance.

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NEW YORK CITY DEPARTMENT OF FINANCE
PAYMENT OPERATIONS DIVISION
CREDIT APPLICATION
G
TM
Finance
Individual
Partnership
Corporation
K
K
K
SECTION 1 - APPLICANT INFORMATION
1. Applicantʼs Name: _____________________________________________________________________________
FIRST NAME
LAST NAME
2. Business Name (if applicable): ___________________________________________________________________
/
/
3.
______
______
______
4
Date of Birth, filing or incorporation:
. Tax ID Number:
-
-
MM
DD
YYYY
5. Telephone
Number: _________________________ _____________________________ ____________________________
HOME PHONE
CELLPHONE
WORK PHONE
6. Current
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
K
K
7. Please Check One:
Own
Rent
8. Monthly Payment or Rent: $______________ 9. How Long?________
10. Previous
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
SECTION 2 - EMPLOYMENT INFORMATION - Individuals Only
1. Current Employer: _____________________________________________________________________________
2. Employer
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
3. Telephone
Number: ___________________ 4. Email:_______________________________ 5. Fax: __________________
K
K
6. Position: ____________________ 7. Please Check One:
Hourly
Salary 8. Annual Income: $ ___________
9. Previous
Employer:________________________________________________________ 10. How Long?
_____________
11. Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
12. Telephone
Number: ___________________ 13. Email:______________________________ 14. Fax: _________________
K
K
15. Position: ____________________ 16. Please Check One:
Hourly
Salary 17. Annual Income: $ _________
SECTION 3 -
- Individuals Only
CO-APPLICANT INFORMATION, IF FOR A JOINT ACCOUNT
1. Name: ______________________________________________________________________________________
FIRST NAME
LAST NAME
/
/
______
______
______
2.
3
Date of Birth:
. Social Security Number:
-
-
MM
DD
YYYY
4. Telephone
Number: _________________________ _____________________________ ____________________________
HOME PHONE
CELLPHONE
WORK PHONE
5. Current
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
K
K
6. Please Check One:
Own
Rent
7. Monthly Payment or Rent: $______________ 8. How Long?________
9. Previous
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
Credit Appl.
11.22.11
NEW YORK CITY DEPARTMENT OF FINANCE
PAYMENT OPERATIONS DIVISION
CREDIT APPLICATION
G
TM
Finance
Individual
Partnership
Corporation
K
K
K
SECTION 1 - APPLICANT INFORMATION
1. Applicantʼs Name: _____________________________________________________________________________
FIRST NAME
LAST NAME
2. Business Name (if applicable): ___________________________________________________________________
/
/
3.
______
______
______
4
Date of Birth, filing or incorporation:
. Tax ID Number:
-
-
MM
DD
YYYY
5. Telephone
Number: _________________________ _____________________________ ____________________________
HOME PHONE
CELLPHONE
WORK PHONE
6. Current
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
K
K
7. Please Check One:
Own
Rent
8. Monthly Payment or Rent: $______________ 9. How Long?________
10. Previous
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
SECTION 2 - EMPLOYMENT INFORMATION - Individuals Only
1. Current Employer: _____________________________________________________________________________
2. Employer
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
3. Telephone
Number: ___________________ 4. Email:_______________________________ 5. Fax: __________________
K
K
6. Position: ____________________ 7. Please Check One:
Hourly
Salary 8. Annual Income: $ ___________
9. Previous
Employer:________________________________________________________ 10. How Long?
_____________
11. Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
12. Telephone
Number: ___________________ 13. Email:______________________________ 14. Fax: _________________
K
K
15. Position: ____________________ 16. Please Check One:
Hourly
Salary 17. Annual Income: $ _________
SECTION 3 -
- Individuals Only
CO-APPLICANT INFORMATION, IF FOR A JOINT ACCOUNT
1. Name: ______________________________________________________________________________________
FIRST NAME
LAST NAME
/
/
______
______
______
2.
3
Date of Birth:
. Social Security Number:
-
-
MM
DD
YYYY
4. Telephone
Number: _________________________ _____________________________ ____________________________
HOME PHONE
CELLPHONE
WORK PHONE
5. Current
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
K
K
6. Please Check One:
Own
Rent
7. Monthly Payment or Rent: $______________ 8. How Long?________
9. Previous
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
Credit Appl.
11.22.11
Credit Application
Page 2
SECTION 4 - CO-APPLICANT EMPLOYMENT INFORMATION - Individuals Only
1. Current
Employer: ____________________________________________________________________________________
2. Employer
Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIPCODE
3. Telephone
Number: ___________________ 4. Email:_______________________________ 5. Fax: __________________
K
K
6. Position: ____________________ 7. Please Check One:
Hourly
Salary
8. Annual Income: $ ___________
9. Previous
Employer:________________________________________________________ 10. How Long?
_____________
11. Address: _____________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIPCODE
12. Telephone
Number: ___________________ 13. Email:______________________________ 14. Fax: _________________
K
K
15. Position: ____________________ 16. Please Check One:
Hourly
Salary
17. Annual Income: $ _________
SECTION 5 - BANK INFORMATION
Name
Account Number
Checking or Savings
SECTION 6 - CREDIT CARD INFORMATION
Name
Account Number
Current Balance
Monthly Payment
SECTION 7 - MORTGAGE COMPANY INFORMATION
Name
Account Number
SECTION 8 - AUTO LOAN INFORMATION
Auto Loans
Account Number
Balance
Monthly Payment
SECTION 9 - OTHER LOANS, DEBTS, OR OBLIGATIONS INFORMATION
Description
Account Number
Amount
SECTION 10 - OTHER ASSETS OR SOURCES OF INCOME
Description
Amount Per Month or Value
I authorize NYC Department of Finance to verify the information provided on this form as to my credit and employment history.
Signature of Applicant
Date
Signature of Co-Applicant, If for Joint Account
Date
P P R R I I V V A A C C Y Y A A C C T T N N O O T T I I F F I I C C A A T T I I O O N N
The Federal Privacy Act of 1974, requires us to state the following if we ask for your Social Security Number. You must list your Taxpayer
Identification Number, Social Security Number or Employer Identification Number in order to enter into a Payment Agreement. We ask
for this information in order to assure the Real Property Tax Records are accurate and that you have paid all the City Taxes. Our legal
right to require this information is contained in section 11-120.1 of the Administrative Code. This section of law authorizes the Department
of Finance to require any person to provide Taxpayer Identification Number so that we may administer and collect taxes.
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