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Loan Application
Address of Collateral:
Amount of Loan Requested:
Borrower’s Opinion of Value:
Purpose of Loan:
Applicant Information
FIrst Name:
MI:
Last Name:
Primary Phone:
Cell Phone:
Email:
Date of Birth:
Driver’s Lic: State:
Driver’s Lic: #
Soc. Sec. #:
Current Address:
Apt.
City:
State:
Zip:
How long at this address (years):
Landlord/Mortgagee:
Phone:
Monthly Rent/Mortgage Pmt:
Name of Nearest Relative (Not living with you)
Phone:
Address:
City:
State:
Zip:
Current Employer:
Address:
Supervisor’s Name:
Phone:
Monthly Income:
Position:
Length of Employment (years):
Co-Applicant Information
FIrst Name:
MI:
Last Name:
Cell Phone:
Primary Phone:
Email
Date of Birth
Driver’s Lic: State
Driver’s Lic: #
Soc. Sec. #:
Current Address:
APT.
City:
State:
Zip:
How long at this address (years):
Landlord/Mortgagee:
Phone:
Monthly Rent/Mortgage Pmt:
Current Employer:
Address:
Supervisor’s Name:
Phone:
Monthly Income:
Position:
Length of Employment (years):
Check the correct answer for the questions below.
Has Applicant ever:
Been evicted?
Yes
No
Filed bankruptcy?
Yes
No
Lost property due to foreclosure?
Yes
No
Had any credit problems?
Yes
No
Been convicted of a felony?
Yes
No
If the answer to any of the preceding questions is "Yes", explain (attach additional documents if necessary):
Representation:
Applicant and Co-Applicant represent that the above statements are true, complete, and correct. Providing false information or intentional or negligent misrepresentation of the information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation made in this application. The lender or its assigns may retain a copy of this application, whether or not the loan is approved.
Authorization:
Applicant and Co-Applicant authorize Lender or Lender’s agent to: (1) obtain a copy of any consumer or credit report related to this application; and (2) verify any rental history, employment history, or any other information related to this application; and (3) discuss information in the consumer report with Lender or Lender’s agent
By submitting this application, you and your co-applicant (if applicable) agree that your first and last names will be used as an electronic signatures on the form.
Submit
