Personal Funding Application

PERSONAL FUNDING APPLICATION

Complete all sections fully. Inaccurate, incomplete or false statements may delay processing or result in denial. Applicant must sign and date at the end to certify authorization and representations contained in this application.

Applicant Information

Full legal name:

Date of birth:    Last 4 of SSN:

Time at address:    Previous address (if less than 2 years):

Employment and Income

Job title:    Employment start date:

Funding Request

Amount requested: $    Desired term (months):

Proposed repayment start date:    Will collateral be offered? Yes No

Assets and Liabilities

References

Declarations, Authorizations and Certification

Representation: Applicant affirms that all information provided in this application is true, complete and correct to the best of Applicant's knowledge. Applicant understands that any intentional misstatement or omission may constitute fraud and may result in denial of the application or termination of any funding.

Authorization to verify: Applicant authorizes the lender, its agents and assigns to obtain consumer credit reports, employment and income verification, and to contact references and other third parties for the purpose of evaluating this application. Applicant authorizes any such party to disclose information requested.

Use of information: Applicant consents to the use and disclosure of personal information provided in this application for underwriting, servicing, collection and as required by law. Applicant consents to receive communications at the contact information provided, including electronic communications where applicable.

Conditional funding and terms: Applicant acknowledges that completion of this application does not constitute approval. If approved, funding will be subject to the lender's terms and conditions, including interest rate, fees, repayment schedule and security interest if applicable, as set forth in the final loan agreement or promissory note.

Fraud warning: Providing false or misleading information in order to obtain funds may result in civil or criminal liability.

Consent to electronic signatures: Applicant agrees that an electronic signature is the legal equivalent of a handwritten signature and may be used to execute loan documents if the application is approved.

Certification: I certify under penalty of perjury that the information provided in this application is true, complete and accurate.

Applicant certification I certify the foregoing

Additional Acknowledgements

Sign Now