Indian-Victory Gilroy Credit Application
Type in your information, print the page and fax or mail to:
or Call our Finance Department.
Indian-Victory Gilroy
7191 Monterey Road
Gilroy CA 95020-6615
Phone: (408) 848-2262
Fax: (408) 848-3678
1. Tell Us About Yourself

First Name


Middle Initial

Last Name

Suffix (Jr./Sr./etc.)

Home Phone

- -
Date of Birth

Social Security Number


Mother's Maiden Name

Number of Dependents
2. Home Address

Present Address

Apartment Number




ZIP Code

Do you currently?

Own   Rent   Other

Length at current address:



3. About Your Job

Name of Business


Business Phone

 -   - 

Years with Current Employer


Previous Employment Time, if less than 2 years

4. About Your Income

You do not have to disclose alimony, child support, spousal income, separate maintenance agreement or its source, unless you want it to be considered for this application.

Yearly Total Income

$ .00        
5. E-Mail

E-mail Address

Re-enter E-mail Address