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Personal
Data
Name of Youth Shooter (last, first,
middle) _______________________ ____________________________________
Social Security Number
- -
Birthdate _____/_____/______ Date
of Application _____/______/_____
Name of Parent/Guardian (last,
first, middle) _______________________ ____________________________________
Social Security Number
- -
Birthdate _____/_____/______ Number of Dependent/Ages________
Mailing Address ______________________________
City ______________ State
____ Zip______ Years_____
Physical Address _____________________________
City ______________ State
____ Zip______ Years_____
Home Phone (
)__________________________
Work Phone ( )_________________________
Have you ever delcared Bankruptcy? ____________
Had a Repossession? ___________ Judgement?___________
Email Address _______________________________________________________
Registered in which Shooting Association?_______________________
Membership #________________________
Driver's License Number_____________________________________________
State________________
Parent's
or Guardian's Employment
Employer_____________________________________________
Years at this Company____________________
Address_______________________________________
City______________ State__________
Zip________
Phone ( )________________________
Title_____________________ Salary/Wages(Gross)______________
Previous Employer______________________________________
Years at this Company____________________
Address_______________________________________
City______________ State__________
Zip________
Personal and Credit References
Personal Reference:
Name_______________________________________ Relationship_______________________
Address____________________________
City___________________ State___________
Zip_______________
Name of Creditor/Credit Card_______________________________
Account Number___________________________
Address/Branch___________________________________________________________________________________
Date Opened__________________________
Balance__________________ Monthly Payment__________________
I
certify that the statements herein are true and that I am not liable
for any debts, other than specifically listed. Europa Corporation,
d.b.a. duPONT/KRIEGHOFF is authorized to obtain any information which
it deems necessary for consideration of the credit request and during
the credit transaction, if approved.
Signature (Youth
Shooter) ________________________________________________________________
Date_____________
Co-Signature (Parent/Guardian)
___________________________________________________________ Date_____________
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