EmpowerCredit Loan Application

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If you have not lived at this address for more than one (1) year, please list your previous three addresses here:

Email

example@example.com

Home Phone

Please enter a valid phone number.

Work Phone

Please enter a valid phone number.

Cell Phone

Please enter a valid phone number.

Date of Birth

Date

SS#

Employer

Supervisor

First NameLast Name

Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employer Phone

Please enter a valid phone number.

Employer Email

example@example.com

Years Worked

Title

Monthly Income

Pay Frequency:

Pay Days/Dates

If additional employers, please list same information for each here:

Please List Three (3) Personal References:*

Name and Contact Information for Parent or other Relative

Please list any existing debts, including current pay day loans. Please list the name and contact information for lender, the amount owed, and the date ranges of each loan:*

Do you have a savings account?

yesno

Do you know what your monthly budget is?

yesno

Please list your monthly expenses. Be specific and detailed.

Please explain why this loan is needed. Please list the name and contact informaiton for any person or business to whom this loan would be paid.

I, blanks (please type full name) certify that:

all information provided is true to the best of my knowledge
I give permission to Transformation Nashville to conduct a personal and/or financial background check and to contact any references and employers listed.

I understand and agree that, if approved for a loan, it is my responsibility:to make all contacts necessary to enroll in an approved finance class within thirty (30) days of such approval and to then furnish the proof to Transformation Nashville by emailing such proof to loans@transformationnashville.org  to complete the class as scheduled.

to communicate to Transformation Nashville any changes to the information in this application by emailing loans@transformationnashville.org within forty-eight (48) hours of such change.          I agree that my information can be used in fundraising and/or other communications of Transformation Nashville.
my name can be used
my image can be used

Signature

Date