Employment Information
Consumer Loan Application
Borrower Information:
Complete the Applicant Information section for the Applicant. Mark the appropriate box to indicate whether the Applicant is applying as a Borrower, Cosigner, Guarantor, Grantor (of collateral), or Other for a different capacity. All Cosigner's, Guarantor, and/or Grantors must fill out their own separate application.
Name
*
First Name
Middle Name
Last Name
Upload Government Issued Valid ID
*
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Drag and drop files here
Choose a file
Ex: Drivers License, Passports, Ect.
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Birth Date
*
Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
2026
2025
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Year
Borrower Type
*
Borrower
Cosigner
Guarantor
Grantor
Other
Marital Status
Single
Married
Other
SSN:
*
E-mail
*
example@example.com
Phone #:
*
Best Time to Reach You?
Morning 9:00AM to 12:00PM
Anytime
Afternoon 12:00PM to 5:00PM
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived in your given address?
0-1 Year
1-2 Years
3-4 Years
5+ Years
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Loan Details
Desired Loan Amount $
*
Desired Funding Date
*
Desired Monthly Payment $
*
Preferred Monthly Payment Due Date
Payments are typically due on the 1st or 15th of each month
Collateral Offered
*
Please Select
Personal Vehicle
Real Property
Savings
Other
Please select the asset type that will be pledged as collateral for this loan.
Please list all owners of Real Property
*
Please note each owner will need to fill out a separate loan application
VIN Number:
*
Please type the 16 digit VIN number for the vehicle you will be pledging as collateral for the loan.
Year, Make, and Model
Please type Year, Make, and Model for the vehicle you will be pledging as collateral for the loan.
Current Mileage
*
Please type current mileage for the vehicle you will be pledging as collateral for the loan.
Real Property Address:
*
Please type the address for the real property you will be pledging as collateral for the loan.
Estimated Market Value of Collateral
*
Please type the dollar amount you estimate the collateral for this loan is worth.
Specific Purpose of Loan
*
Upload Collateral Documentation
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EX: Vehicle Title, Mortgage Statement, or other Proof of Ownership in collateral
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Present Employer
*
Organization Name
Occupation
*
Years of experience in current position
*
0-1 Year
1-2 Years
3-4 Years
5+ Years
Former Employer
Organization Name
Past Occupation
Years of experience in last position
0-1 Year
1-2 Years
3-4 Years
5+ Years
Gross Monthly Income
*
Monthly Housing Expense: (rent/mortgage)
*
Down Payment Amount
Depending on the Market Value of your Collateral Offered, a down payment may be required. Please list an amount you can cover if necessary.
Do you have any Existing Debts?
*
Please Select
Yes
No
Upload Proof of Income
*
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Please upload Proof of Income for the last 60 days (Ex: Paystubs, 1099, W-2's, Tax Return, Financial Statements, Ect.)
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Upload Existing Debt Statements
*
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Please upload your most recent debt statements for all other debts you currently have. (Including Credit Card debts, Personal debts, Mortgage Statements, ect.)
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Additional Comments
Please select your Loan Officer
*
Please Select
Chris Wyatt
Jesse Davis
Joy Kingston
Robert Kingston
Vesta Davis
Other Loan Officer
Not currently working with any Loan Officer
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Credit References
Est. Credit Score:
*
Source used to get credit score:
Bank References:
Personal References:
Are you currently involved in any on-going lawsuits or litigations?
*
Yes
No
Consent
I authorize prospective Credit Grantors/Lending/Leasing Companies to obtain personal and credit information about me from my employer and credit bureau, or credit reporting agency, any person who has or may have any financial dealing with me, or from any references I have provided. This information, as well as that provided by me in the application, will be referred to in connection with this lease and any other relationships we may establish from time to time. Any personal and credit information obtained may be disclosed from time to time to other lenders, credit bureaus or other credit reporting agencies.
*
YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission.
*
YES
I acknowledge that if my loan is approved I will be responsible to pay a loan fee, which will either be 1% of the approved loan amount, or $250.00 whichever is greater. (Fees are subject to change based on the qualifications of the borrower)
*
YES
I acknowledge that my application will automatically expire within 60 days of the submission date if it has not been approved or extended. In the event of my application being cancelled, I understand that I may be required to resubmit a new application.
*
YES
I acknowledge that if I am unresponsive to additional information requests, my loan application may be cancelled within 30 days of no response.
*
YES
Borrower's Signature
*
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