Clone of Loan Questionnaire- Shatorrey Crumpler

Loan Questionnaire
Desired Loan Amount $ Min. $10k / Max$500k
Annual Income $
CREDIT SCORE- Please provide all 3 scores ( if known)
Loan will be used for

Business LaunchingReal EstateHome ImprovementInvestmentEducationOther
Contact Information
Name

TitleFirst NameLast Name
Birth Date

MonthDayYear
Marital Status:

SingleMarriedOther
E-mail
example@example.com
Phone
Format: (000) 000-0000.
Citizenship

U.S. CitizenNon-Permanent Resident Alien
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived in your given address?

0-1 Year1-2 Years3-4 Years5+ Years
Have You Ever Been Late on Any payments in last 2 yrs

YesNo
Do You Have at least 3 Trade Lines of Credit? (ex. Auto, Home, Credit Car..)

YESNO
DO YOU HAVE ANY JUDGMENTS, LATE PAYMENTS OR COLLECTIONS ON CREDIT PROFILE?

YESNO
ARE YOU A W-2, 1099 EMPLOYEE OR BOTH

W21099BOTH
HAVE YOU EVER FILED BANKRUPTCY?

YESNO
HAVE YOU APPLIED FOR AUTO FINANCING IN PAST 12 MOS.

YESNO
HAVE YOU EVER UTILIZED CREDIT REPAIR/RESTORATION SERVICES

YESNO
HAVE YOU APPLIED WITH ANY OTHER LENDER IN LAST 6 MOS.

YESNO
HAVE YOU APPLIED FOR ANY NEW CREDIT CARDS OR FUNDING IN THE LAST 6 MOS.

YESNO
DATE/TIME OF SUBMISSION
Gross monthly income
Monthly rent/mortgage
Comments
Consent
I understand that this quick questionaire is for pre-qualification purposes only and that a funding consultant can and will contact me to pre-qualify me for a Personal Loan / Gap Funding. I agree & consent to an Account Executives to reach out to me to discuss any potential concerns or questions I may have or to proceed with the full application to obtain formal approvals!

YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission.

YES
Appointment
Assigned Agent

Lisa Shorter
HOW DID YOU HEAR ABOUT US
Should be Empty:

Loan Questionnaire

Contact Information

Consent