***THIS IS AN APPLICATION FOR A LINE OF CREDIT WITH MULTIPLE CREDIT FUNDING COMPANIES

*denotes required fields

PERSONAL INFO:
First*
Middle*
Last*
Social Security Number*
Date of Birth*
Email Address*

PHONE:

Primary
Secondary

ADDRESS:

Street
City
State
Zipcode

LIVING STATUS

Home Rent/Own
Monthly Rent/Mortgage Payment
Total Annual Income
How long have your been at this residence?

EMPLOYMENT:

Employment Status - Self / Retired / Student / Unemployed / Other
Company (or "None" if you have no Employer)
Occupation
Employer Phone
Length of Employment
Would you be interested in blank checks to use for cash advances?

FINANCES

Do you have a Checking Account
Do you have a Money Market Account
Do you have a Savings Account
Do you have a IRA Account
What is the total balance of all your bank accounts? (ie: checking, savings, and money market accounts?
Do you have any Investment Accounts
What is the total value of investment accounts? (ie: 401k, brokerage accounts?

SECURITY INFO:

Ideal place to vacation?
Mothers Maiden Name
US Citizen

PERMISSION TO OBTAIN CONSUMER CREDIT REPORT

I do hereby authorize Exclusive Vacations to electronically submit this application on my behalf to multiple credit funding companies. I do acknowledge that Exclusive Vacations shall be no part of the decision making process in this extension of credit that will or will not be offered by Capital One, Citibank, American Express, Chase, and/or Barclay Banks. All credit decisions are determined by the credit funding companies. I understand and agree this is an application for credit. Upon approval, I agree to the servicing of the new account, whether I accept or decline the purchase agreement with Exclusive Vacations.

Select YES, I agree to the above Conditions
ENTER FULL NAME
DATE YYYY-MM-DD