KLPP Online Inquiry Form

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INQUIRY FORM SUBMISSION

This provides a quick overview of your financial situation to determine if you meet the minimum standard for pre-qualification.

LENGTH OF EMPLOYMENT/INCOME

Must be employed at current job for a MINIMUM of 12 consecutive months OR,
Must be employed at current job for a MINIMUM of 6 consecutive month AND
Must demonstrate a minimum of 12 consecutive months of employment at a single previous employer with no more than 1 month between employers.
If you receive a fixed income (SSI, SSDI, Child Support, TANF, etc.) you must demonstrate this income has been received for a MINIMUM of 18 consecutive months prior to submitting this inquiry

INCOME GUIDELINE

All household income of the applicant must demonstrate a MINIMUM MONTHLY TAKE-HOME INCOME that is no less than 50% of the loan amount requested.
Discretionary income (remaining funds after expenses, not including predatory loan payments) must be, at MINIMUM, $150.

Today's Date*

Date

KLPP ReliefKLPP Loan Alternative

County of Residence*

Applicant Name*

First NameMiddle NameLast Name

Applicant Date of Birth*

Date

Social Security Number

Best Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

CellHomeWorkMessage Only

Email Address*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YesNo

If yes, how many online payday loans do you have?*

YesNo

If yes, how many title loans do you have?*

What is the total dollar amount you owe to payday, lines of credit, and/or title loans?*

YesNo

Where are you employed?*

How long have you worked here?*

What is your hourly wage?*

How many hours do you work per week?*

WeeklyBi-WeeklyMonthlyOther

What is your monthly TAKE-HOME pay?*

YesNo

If yes, where did you work before?*

If yes, how long did you work there?*

What are your TOTAL monthly expenses, including predatory loan payments?*

How many ADULTS reside in your household?*

How many CHILDREN reside in your household?*

YesNo

Applicant Signature

KLPP INQUIRY FORM

Applicant Information

Loan Information

Income Information