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Apply for a Loan:

Please fill out the form below. You can also download this application in PDF format and mail or fax (1-800-476-2479) it to us.

1. BORROWER INFORMATION
Name: (Required)
Date of Birth:
Social Security Number:
Address:
City:
State:

Zip:
Email: (Required)
Home Phone: (Required)
Cell Phone:

2. BORROWER EMPLOYMENT / INCOME INFORMATION:
Employment:



Self Employed:

Annual Gross Income:
$
Employer Name:
Occupation:
Employer Address:
City:
State:

Zip:
Employer Phone:
Years Employed:
Retirement Income:
$
Source:
Amount:
$
Source:
Amount:
$

3. CO-BORROWER INFORMATION:
Name:
Date of Birth:
Social Security Number:
Cell Phone:
Email:

4. CO- BORROWER EMPLOYMENT / INCOME INFORMATION:
Employment:



Self Employed:

Annual Gross Income:
$
Employer Name:
Occupation:
Employer Address:
City:
State:

Zip:
Employer Phone:
Years Employed:
Retirement Income:
$
Source:
Amount:
$
Source:
Amount:
$

5. LIQUID ASSET INFORMATION:
Checking: Savings/CDs: Stocks/Bonds/MutFund:
IRA: 401K: Other (TSP, 403b, etc.):

6. CONSUMER DEBT INFORMATION:
Credit Cards: Car Loans: Misc. Loans/Debt:
Approx. Total Consumer Debt:

7. PROPERTY INFORMATION:
Property Type:
Single Family Townhouse Condo
Year Purchased:
Purchase Price:
Current Market Value:
$
Interest Rate:
%
Home Phone:
Mortgage Company:
1st Mortgage Balance:
$
Monthly Payment:
$
Mortgage Company:
2nd Mortgage Balance:
$
Monthly Payment:
$
Does your payment include taxes and insurance:
No

8. Optional - HOME IMPROVEMENT COMPANY/ REPRESENTATIVE INFORMATION:
Home Improvement Company Name:
Home Improvement Company Phone:
Project Amount:
$
Dealer: (Required - if no dealer chosen, put "none" in the field below)
Email:
Down Payment:
$

9. Additional Comments


You must fill in all the required fields above or your form will not be submitted.