Name (if any): _______________________________
                Middle      Last        First
Address: _____________________________________

Last 34 addresses: ___________________________

Sex:  __ Male   __ Female   __ Not Sure

Are you an illegal alien?  __ Ja  __ Si  __ Oui  __ Da

Annual income: $________
(If over $3,000, where did you get the nerve to beg us for a loan?)

Astrological sign: ____________ (Stop here if you're a Leo or Taurus)

Grandmother's maiden name: ________  Her World War II service record?: ______

Last book you read:
__ The Joy of Saxaphone  __ Mad  __ Manhattan telephone directory

Your favorite number from 17 to 39: __  (this will be the interest on your loan,
if you're lucky enough to get one from us)

Are you now on the FBI's "Ten Most Wanted" list?  __ Yes  __ No

In 7,000 words or more, discuss the International Monetary Fund and its
ramifications related to the Chicago White Sox infield and Victorian matters:
(use back side, if needed)

If you miss a payment on your loan, what is your preferred method of torture?
__ The Rack  __ Iron Maiden  __ A night with Lawrence Welk

Do you like to fill our forms?  (We have more when you complete this one)
__ Yes  __ Goodbye

Do you secretly like your father's Oldsmobile?  __ Yes  __ Maybe a little

Do you sleep in:  __ Pajamas?  __ Underwear?  __ Nude?

State your college major.  (Must be one of these to qualify for student loan)
__ Swine diseases  __ Harpsichord tuning  __ History of chewing gum

Do you still believe in:
__ Santa Claus?  __ Easter Bunny?  __ Professional wrestling?

Are you willing to be polygraphed, scrutinized, notarized, and steroid tested to
obtain a loan from us?  __ Absolutely  __ Positively  __ You betcha  __ Sure
__ Of course  __ Certainly  __ No problem

If all of the above is the truth, the whole truth, and nothing but the truth,
sign here in the presence of 12 witnesses (preferrably Supreme Court Justices
and Nobel Prize winners)

_______________    ________
Signature          Date