Loan Application Form

LOAN APPLICATION FORM

Lender Name:    Application Date:

Applicant Information

Social Security / Tax ID:    Date of Birth:

Phone:    Email:    Years at Address:

Employment & Income

Employer Address:

Position/Title:    Start Date:    Monthly Gross Income:

Co-Applicant / Business (if applicable)

Co-Applicant Name:    Co-Applicant SSN:

Requested Loan Details

Loan Purpose:

Desired Loan Amount:    Desired Term (months):    Desired Interest Rate (if applicable):

Repayment Frequency:    Preferred First Payment Date:

Assets & Liabilities (Summary)

Assets

Cash & Bank Balances:    Investments:    Real Estate Equity:

Liabilities

Mortgage / Rent Payment:    Auto Loan Balance:    Credit Card Balances:

Declarations

Have you declared bankruptcy in the past 10 years?

Are you currently in default on any loan or obligation?

Will a co-signer be required for this loan?    If yes, Co-signer Name:

Documents Provided (check all that apply)

Government ID    Recent Paystubs    Bank Statements

Tax Returns    Appraisal / Valuation    Other:

Authorization, Certification & Notices

By signing below, I certify that the information provided in this application is true, complete and correct to the best of my knowledge. I understand that knowingly making a false statement in this application may be a criminal offense and may result in denial of credit or criminal prosecution.

I authorize the Lender and its agents to verify the accuracy of the information provided, to obtain consumer credit reports and underwriting information, and to contact employers, financial institutions, and other listed references. I further authorize any such parties to release information necessary to process and service the loan request. This authorization shall remain effective for the duration of the application process and until the loan is paid in full if credit is extended.

I acknowledge receipt of and consent to collection, use and disclosure of personal information for purposes of credit evaluation, loan servicing, loss mitigation and fraud prevention. I understand that the Lender may share information with affiliates, service providers, and credit bureaus as permitted by law.

I understand that approval is subject to credit approval, verification of information, and Lender underwriting. I agree that any credit extended will be subject to a separate loan agreement which will include terms for repayment, interest, fees, default remedies, and applicable governing law.

Equal Opportunity: Lender evaluates applicants without regard to race, color, religion, national origin, sex, marital status, age (provided the applicant has capacity to contract), or because all or part of the applicant's income is derived from any public assistance program.

Signatures and Acknowledgement

The undersigned acknowledges that this application is not an approval or an offer of credit. The undersigned further acknowledges that additional documentation and verification may be required and that submission of this application does not obligate the Lender to make a loan.

Sign Now