GENERAL PERSONAL LOAN INTAKE FORM

GENERAL PERSONAL LOAN INTAKE FORM
PERSONAL INFORMATION
Name

First NameLast Name
DOB

MonthDayYear
Date
US CitizenPermanent Resident AlienType option 3Type option 4
US CitizenPermanent Resident AlienMarriedDivorcedSingleWidowed
Credit Score
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
OWNRENTOTHER (explain in comments)
EMPLOYER INFORMATION
Employer

NAMEPHONE NUMBER
W2Retired1099 4Other (explain in comments)
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
LOAN INFORMATION
AMOUNT NEEDED
HOW QUICKLY DO YOU NEED FUNDS

ASAP30 DAYS60 DAYS+OTHER (explain in comments)
PURPOSE OF LOAN

PERSONALBUSINESSCONSOLIDATIONLINE OF CREDITSTART UPCAPITALEQUIPMENTPAYROLL
DECLARATIONS
Outstanding Judgments?

YESNO
BANKRUPTCY PAST 7 YEARS

YESNO
FORECLOSURE PAST 7 YEARS

YESNO
OBLIGED ON ANY LOANS RESULTING IN LAWSUIT

YESNO
DELINQUENT OR DEFAULT ON ANY LOANS

YESNO
PARTY TO ANY LAWSUITS

YESNO
LATE PAYMENTS IN PAST 2 YEARS

YESNO
AT LEAST 60% AVAILABLE ON CREDIT CARDS

YESNO
IF MORE THAN 1 LENDER IS NEEDED TO OBTAIN YOUR LOAN AMOUNT, DO YOU CONSENT?

YESNO
COMMENTS
You declare that all the information collected on this form is accurate and true to the best of your knowledge.

You authorize Inexhaustible Capital to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Inexhaustible Capital and to each of the Recipients, on its own behalf.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

GENERAL PERSONAL LOAN INTAKE FORM

PERSONAL INFORMATION

EMPLOYER INFORMATION

LOAN INFORMATION

DECLARATIONS