Unsecured Loan Application Form

Unsecured Loan Application
Name of Applicant*

PrefixFirst NameMiddle NameLast Name
E-mail of Applicant*
Phone number of Applicant

Area CodePhone Number
Mobile Phone number of Appliicant

Area CodePhone Number
Address of Applicant*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Date of Birth of Applicant*

MonthDayYear
Are you a US citizen*

YesNo
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harrismoney.com/creditrepair
Please enter your social security number (optional)
Experian (If Known)
Equifax (If Known)
TransUnion (If Known)
How long have you been in your current job/company?
Have you applied for a home/commercial property loan in the past 12 months?

YesNo
Have you you applied for funding or new credit accounts in the last 6 months?

YesNo
Do you have a personal checking account which has been open for at least 3 months?

YesNo
Have you applied for auto financing within the last 12 months?

YesNo
Have you ever had credit repair or credit restoration?

YesNo
Have you worked with any other lenders within the last 6 months?*

YesNo
Have you opened any new revolving accounts in the last 6 mos?*

YesNo
If retired or receiving social security, do you have an awards letter?*

YesNo
If you have filed bankruptcy in the last 10 years, what was the filing year?
We hope to fund your loan very soon! How did you learn about us?
Loan Reason

Startup FundingAsset PurchaseRefinancingWorking Capital (with real estate)Working Capital (without real estate)Debt ConsolidationPersonal Loan RequestOther
Desired Amount of Funding*
Type of employment*

W-21099Self EmployedRetirementOther
Employer Name
Job Title/Occupation
Annual Salary
Which of the following can you use to verify your income

Pay StubsW-2Tax ReturnsI have income or other documents I want to upload now
Insert "other" documents here

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Upload Proof of Income (W-2, Pay Stubs, 1099, Tax Return(s)

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Upload Bank Statement (1)

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Upload Bank Statement (2)

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The information provided in this application shall not be shared to anyone else and is kept confidential
I agree that the information herein are true and correct*

Yes
Please Check*

I have read the Terms and Conditions and privacy notice
Applicant Name Print *

First NameLast Name
Applicant Signature *
Date*

MonthDayYear
Date
How did you hear of us?
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