AvaMods 5.o Forums - just registered =)

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AvaMods Forum Posters License
Application & Background Check
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Answer questions 1-20 using the #2 pencil provided. Do NOT write in shaded
areas. Answer questions 1-16 only.
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PLEASE TELL US ABOUT YOURSELF (type or use black ink only)
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1. Last Name:_______________________ 2. First Name:_______________________
3. Date of birth (day/year/month):______________/_____________/___________
5. Age (in months):_________________ 6. Present ZIP Code:_________________
7. Present Address (number, street, city, state):
__________________________________________________ ________________________
8. Previous address:__________________________________________ ____________
9. Number of children (including spouse):_________________________________

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PLEASE TELL US ABOUT YOUR WORK AND FINANCES (Use a #4 pencil only)
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10. Employer's Name:________________ 11. Years at current job:____________
13. Primary annual income:$_________ Explain:_____________________________
14. Bank Name:______________________ 14A. Account number:_________________
14B. Type of account(s):
___ Checking ___ Savings ___ Other
15. Check one:
___ Own Home ___ Rent
___ Own condo/co-op ___ Other
16. Assets (check all you own, except as checked in question 15):
___ Auto (see question 6) ___ Home
___ Stereo ___ VCR
___ Major appliances ___ TV (Circle one:
Color/Black-and-white)
17. Second co-mortgagee of subscriber's trustee (including first part;
use other side if necessary):_______________________________________ ______
If none, give alternate and explain:______________________________________

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PLEASE SIGN THIS AUTHORIZATION. By signing below I hereby authorize AvaMods
to check my credit history and permanent record. If I am
issued an AvaMods Forums Posters License I authorize AvaMods to exchange
information about me with credit bureaus, clans and institutions doing
business in North America, Europe, Asia, South America, Australia, Africa,
Antartica, Guam, or elsewhere, or with any person or persons that AvaMods
may so choose, from time to time, without recourse. By
signing below, I hereby absolve AvaMods of any
misrepresentations of fact about me, and I agree to pay for any
charges which are billed to my account by AvaMods or its
members. I understand that failure to answer questions 4 and 12
invalidate this application.
Signature_________________________________________