FALL RIVER COUNTRY CLUB
P.O. BOX 244 / 4232 NORTH MAIN STREET
FALL RIVER, MA 02722-0244

MEMBERSHIP APPLICATION

NAME_________________________________________DATE____________________

ADDRESS_______________________________________________________________

CITY_________________________________STATE__________ZIP_______________

HOME TELEPHONE________________________BUSINESS_______________________

EMAIL ADDRESS_________________________________________________________

SPOUSE'S NAME_________________________________________________________

MEMBERSHIP CATEGORY REQUEST ________________________________________

PAST OR PRESENT CLUB AFFILIATION _____________________________________

HANDICAP, IF ANY _______________________________________________________

SPONSOR ______________________________________________________________

SPONSOR ______________________________________________________________

FOR FRCC USE ONLY

DATE OF BOARD MEETING ________________PAYMENT RECEIVED ________________

DATE ACCEPTED ____________________________________________________________

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CREDIT APPLICATION

                                                                                 Type or Print Clearly

Subscriber Name: FALL RIVER COUNTRY CLUB                                     TCSI NO.:____________

Requested Purpose: Establish Member Credit Line with Club

This section must be completed

Applicant:______________________________________________SS#:______-_______-______


Home Phone:_________-_________-__________      Date of Birth _______-________-________
                                                                                         Month       Day        Year

Applicant's Identification Type:_______________________Number:_________________________

Current Address:___________________________________________How Long:______________

Previous Address 1:_________________________________________How Long:______________

Previous Address 2:_________________________________________How Long:______________

Current Employer:__________________________________________Phone:______-______-______

Employer Address:_________________________________________How Long:_______________

Position_________________________________________Monthly Income:$_________________

Landlord:________________________________________Phone:______-______-_______

Bank Name____________________________________Checking: YES / NO circle Savings: YES / NO

Co-Applicant:_____________________________________SS#________-________-________

Home Phone:________-________-________                 Date of Birth:________-________-________
                                                                                                Month          Day         Year

Current Address:________________________________________How Long:_________________

Current Employer:_______________________________________Phone:_______-_______-_______

Employer Address:______________________________________How Long:__________________

Position:_____________________Monthly Income: $___________Phone:______-_______-______

Personal Reference:___________________________________Phone:________-________-_______

Personal Reference:___________________________________Phone:________-________-_______  

The undersigned consumer applicant(s) apply to the subscriber named above for an obligation defined as a "legitimate permissible purpose" as indicated above and allowed by the Fair Credit Reporting Act, Public Law 91-508 (FRCA).  By signing below the applicant(s) certify that all the above information is true and correct in every respect.  This application is not for employment or any restricted purpose.  The applicant(s) authorizes the verification of any and all information contained in this application by the subscriber or its authorized designee - TCSI and further authorize the subscriber or its authorized designee - TCSI to obtain a credit report from a so called "Credit Bureau" on each applicant.  The applicant(s) understands and agrees that the decision to grant or deny the request contained in this application is at the sole discretion of the subscriber.

APPLICANT'S SIGNATURE:________________________________DATE:____________________

CO-APPLICANT'S SIGNATURE:_____________________________DATE:___________________

SUBSCRIBER'S SIGNATURE:________________________________DATE:____________________

     Rev. 10-98 CBR-TCSI