Loan Application

Applying For:

If you are applying for individual credit in your own name and are relying on your own income or assets as a basis for repayment of the credit requested, complete only Sections A and C.

If you are applying for joint credit, with another person, complete all Sections, providing information in B about the joint application.

If you are applying for individual credit, but are relying on income from alimony, child support, separate maintenance or on the income or assets of another person as the basis for repayment of credit requested, complete all sections, providing information in B about the person on whose alimony, support, maintenance payments, income or assets you are relying.

SECTION A

Applicant

Amount requested?*

Purpose of loan?*

Where did you hear about us?*

Date of Birth*

# Dependants*

Email address*

Last Name*

First Name*

Middle Initial*

Dwelling*

Own

Rent

Other

Street Address*

City*

State*

Zipcode*

Home Phone/Cell Phone*

Monthly Mtg./Rent Payment*

Since*

Landlord/Mortgage Holder*

Phone*

Previous Address*

City*

State*

Zipcode*

Applicant Income

Employer/Source of Income**

Employer Phone & Supervisor Name*

Position*

Since*

Net Monthly Income*

Date Received*

Previous Employer*

How Long?*

SECTION B

Co-Applicant

Date of Birth

# Dependants

Email address

Last Name

First Name

Middle Initial

Dwelling

Own

Rent

Other

Street Address

City

State

Zipcode

Home Phone/Cell Phone

Monthly Mtg./Rent Payment

Since

Landlord/Mortgage Holder

Phone

Previous Address

City

State

Zipcode

Co-Applicant Income

Employer/Source of Income*

Employer Phone & Supervisor Name

Position

Since

Net Monthly Income

Date Received

Previous Employer

How Long?

Section C

Asset & Debt Information

(If Section B has been completed, this section should be completed using information about both the Applicant and Co Applicant or other person. Please mark Applicant related information with an “A”. If Section B was not completed, only give information about the Applicant in this Section).

Other Assets/Additional Income Source*

*Alimony, child support, separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation, Alimony, child support, separate maintenance received under:

Court Order

Written Agreement

Oral Understanding

I WARRANT THAT THE INFORMATION PROVIDED IN THIS CREDIT APPLICATION IS TRUE AND CORRECT AND PROVIDES ALL EXISTING INFORMATION CONCERNING MY OUTSTANDING INDEBTEDNESS AND CREDITWORTHINESS. NO DEBTS HAVE BEEN OMITTED AND ALL DEBTS HAVE BEEN FULLY DISCLOSED. I UNDERSTAND THAT THE INFORMATION PROVIDED, THE VERIFICATION OF THAT INFORMATION AND ANY CREDIT REPORTS OBTAINED WILL BE REASONABLY RELIED UPON BY LENDER IN APPROVING OR REJECTING THIS APPLICATION. I AUTHORIZE LENDER TO COMMUNICATE WITH THIRD PARTIES AND OBTAIN SUCH INFORMATION AS LENDER MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION AND MY ACCOUNT INCLUDING, WITHOUT LIMITATION, FOR THE PURPOSES OF EXTENDING NEW CREDIT, REVIEWING CREDIT INFORMATION OR COLLECTING MY ACCOUNT. I AUTHORIZE ANY THIRD PARTY TO RELEASE INFORMATION LENDER MAY REQUIRE, NOW OR IN THE FUTURE. THIS AUTHORIZATION INCLUDES, BUT IS NOT LIMITED TO, LENDER CONTACTING CONSUMER REPORTING AGENCIES TO OBTAIN A CONSUMER REPORT AS WELL AS NONAFFILIATED FINANCIAL COMPANIES THAT MAY BE LISTED ON MY APPLICATION OR IN MY CONSUMER REPORT. I FURTHER AUTHORIZE LENDER TO ANSWER QUESTIONS FROM MY PRESENT OR POTENTIAL CREDITORS ABOUT LENDER’S CREDIT EXPERIENCE WITH ME, OR FROM OTHERS WHO I MAY HAVE AUTHORIZED TO RECEIVE SUCH INFORMATION. THIS CONSENT MAY BE REVOKED AT ANY TIME. I UNDERSTAND THAT THE PURCHASE OF CREDIT INSURANCE IS NOT REQUIRED BY LENDER TO OBTAIN A LOAN. I UNDERSTAND THAT I WILL RECEIVE NOTICE OF APPROVAL OR REJECTION OF MY APPLICATION WITHIN 30 DAYS OF THE ACTION TAKEN AND THAT I CAN REQUEST LENDER’S REASONS IF REJECTED. I AUTHORIZE THE LENDER TO MAIL OFFERS FOR NEW LOANS TO ME. I AUTHORIZE THE LENDER TO COMMUNICATE WITH ME THROUGH MAIL, BY PHONE, TEXT MESSAGE OR SOCIAL MEDIA.

Applicant's Name

First

Last

Date*

This field should be left blank