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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:
Active
Retired

Self Employed:
Yes
No

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:
Active
Retired

Self Employed:
Yes
No

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

Other

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:

Yes

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.