Loan Application

Address of Collateral:

Amount of Loan Requested:

Borrower’s Opinion of Value:

Applicant Information

Driver’s Lic: State

Current Address:

How long at this address (years):

Monthly Rent/Mortgage Pmt:

Name of Nearest Relative (Not living with you)

Current Employer:

Supervisor’s Name:

Length of Employment (years):

Co-Applicant Information

Driver’s Lic: State

Current Address:

How long at this address (years):

Monthly Rent/Mortgage Pmt:

Current Employer:

Supervisor’s Name:

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.

Applicant Information

Co-Applicant Information

Check the correct answer for the questions below.

Has Applicant ever:

Email

Phone Number

Loan Application

Applicant Information

Co-Applicant Information

Check the correct answer for the questions below. Has Applicant ever:

Email

Phone Number

Check the correct answer for the questions below.

Has Applicant ever: