Consumer Loan Application

Consumer Loan Application
Type of Loan Needed*
What is the amount you're requesting?*
Is this for an individual applicant or a joint applicant?*

IndividualJoint
Click here for the loan to be in business name
Applicant Information

*Required Fields
Full Name*

First NameMiddle NameLast NameSuffix
Birth Date*

MonthDayYear
Date
Marital Status*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Social Security Number*
Best time to contact you*
Are you a current customer with us?*

YesNo
If not, how did you hear about us?

Internet/WebNewspaperFriend/RelativeRadio
Employment Information
Current Employer's Name*
Job Title*
Current Employer's City*
How many years have you been employed there?*
What is your annual gross income?*
Who do you currently bank with?*
What do you estimate your current credit score to be?*
Have you ever filed for bankruptcy?*

YesNo
If yes, what is the year of discharge?
If employed with current employer less than 2 years, please provide the following:
Previous Employer Name
Work Phone

Area CodePhone Number
Job Title*
Length of Employment
Co-Applicant Information
Name

PrefixFirst NameMiddle NameLast NameSuffix
Current Employer Name
Date of Birth*
Social Security Number*
Work Phone

Area CodePhone Number
Job Title
Annual Net Income
Length of Employment
Years
Months
If employed with current employer less than 2 years, please provide the following:
Previous Employer Name
Work Phone

Area CodePhone Number
Job Title
Length of Employment
Housing Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PrimaryInternational Address
What is your residential status?*

Owning/BuyingRentingOtherLiving Rent Free
Time at Residence
Years
Months
Monthly Housing/Rent Payment*
Purchase Information

If applicable, complete the fields below:
Model Year
Model
Asking Price
Down Payment
Dealership Name
Relative Information
Nearest Relative's Name:*
Nearest Relative's City/State:
Nearest Relative's Phone Number*

Area CodePhone Number
General Application Disclosure
A consumer report may be requested in connection with your application. Upon request, the applicant will be told whether or not the consumer report was requested, and if such report was requested, the applicant will be informed of the name and address of the consumer reporting agency that furnished the report. We may report information about your account to credit bureaus, which may be reflected in your credit report, including late payments, missed payments, or other defaults on your account. Everything that I have stated in this application is correct to the best of my knowledge. I understand that you may retain the information contained in this application whether or not I am approved for the loan. You are authorized to check my credit and employment history and to give my credit history with you to others as allowed by law.
Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not loan is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.

Applicant Signature Clear
Should be Empty:

Consumer Loan Application

Applicant Information

Employment Information

Co-Applicant Information

Housing Information

Purchase Information

Relative Information

General Application Disclosure