Loan Application Questionnaire

LOAN APPLICATION QUESTIONNAIRE

This Loan Application Questionnaire collects financial, employment and background information necessary for the lender to evaluate creditworthiness and collateral. All statements herein are made under penalty of law and will be relied upon in determining eligibility for credit. Applicant must complete all applicable sections and sign the certification at the end.

Applicant Information

Applicant Name:

Years at Address: Monthly Housing Payment: $

Own Rent Other (specify):

Employment & Income

Position/Title: Length of Employment:

Loan Requested

Requested Principal Amount: $ Desired Term:

Interest Rate Requested (if known): Proposed First Payment Date:

Preferred Repayment Frequency: Monthly Bi-weekly Weekly

Assets & Liabilities

Declarations

Have you or any principal of your business ever declared bankruptcy? Yes No

Are there outstanding judgments, tax liens or legal actions against you? Yes No

Have you ever defaulted on a loan or been party to a foreclosure? Yes No

Authorization & Certification

I certify that the information provided in this questionnaire is true, complete and correct to the best of my knowledge. I understand that the lender will rely on this information in deciding whether to extend credit. I authorize the lender and its representatives to verify my employment, income and other information provided, to obtain credit reports and to obtain information from credit reporting agencies, banks, employers and other third parties as necessary to evaluate creditworthiness and collateral. I consent to the release of credit and employment information for these purposes.

I understand that intentionally providing false or misleading information in connection with this application may constitute fraud and may subject me to civil or criminal penalties. I agree to notify the lender promptly of any material changes in the information provided.

Co-Applicant / Guarantor (if applicable)

Co-Applicant Name:

Lender Notes & Terms

Payment Methods Accepted: Checks, Automated Clearing House (ACH), Wire Transfer, Other as approved by lender. Late payment policy: Late fees and interest may be assessed in accordance with loan agreement and applicable law. Applicant acknowledges that any credit extended will be governed by a separate loan agreement containing interest, fees, default terms, remedies and security interests.

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