2.
Loan Request
  Please enter name           Choose income source   If 1. is selected,
  [surname, first name (for   for loan               Choose your employer
  indv.) or bus. Name]
                              1. Employment          1. Tobinco Group
  ______________              2. Trade               2. CAGD/Controller
                              3. Other               3. GAF
                                                     4. Other
                                                     5. More