Johnson Heating & Air Conditioning Loan App

Loan Application
Date *

MonthDayYear
Date
What type of loan are you requesting?*
Are you applying for a loan to help with the cost of a repair or new heating or cooling unit? *
Are you applying Individually or Jointly?*
Do we have permission to speak with Johnson Heating & Air Conditioning in regards to this application?

YesNo
Name of contact at Johnson Heating & Air Conditioning:
Loan Amount Requested:*
Down Payment Amount: *
Describe purchase:*
Include details such as product brand & property improvements.
Additional Comments:
Applicant Information
Current member?*
Name*

First NameLast Name
Birth Date*

MonthDayYear
SSN: *
Marital Status:*

SingleMarriedOther
E-mail*
Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Rent or Own?*
How long have you lived in your given address?*

0-1 Year1-2 Years3-4 Years5+ Years
Monthly rent/mortgage*
Applicant Employment Information
Present Employer*
Occupation*
Years of experience*

>2 Years2-3 Years3-4 Years5+ Years
If less than 2 years, please list past employment:
Gross monthly income - NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.*
Emergency Contact

To be used only if we are unable to get a hold of you in regards to your loan
FULL NAME of closest Relative (not living in your home).*
Relationship to Applicant:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Co-Applicant Information

Complete only if this is for Joint-Application.
Current member?
Name

First NameLast Name
Birth Date

MonthDayYear
SSN:
Marital Status:

SingleMarriedOther
E-mail
example@example.com
Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

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

0-1 Year1-2 Years3-4 Years5+ Years
Monthly rent/mortgage
Co-Applicant Employment Information
Present Employer
Occupation
Years of experience

0-1 Year1-2 Years3-4 Years5+ Years
If less than 2 years, please list past employment:
Gross monthly income
Co-Applicant Emergency Contact

To be used only if we are unable to get a hold of you in regards to your loan
FULL NAME of Closest Relative (not living in your home).
Relationship to Applicant:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Agreement & Disclosure
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
Primary Signature: *
Co-Borrower Signature:
Should be Empty:

Loan Application

Applicant Information

Applicant Employment Information

Emergency Contact

Co-Applicant Information

Co-Applicant Employment Information

Co-Applicant Emergency Contact

Agreement & Disclosure