Loan Application Form

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L OAN AP P L I C AT IO N W OR KS HE ET
APPLICANT INFORMATION
Name:
DL #/State:
Date of birth:
SSN:
Current Street Address:
City:
State:
ZIP Code:
Phone:
E-mail:
Fax:
Own
Rent
Other
(circle one)
Monthly payment or rent:
How long?
Previous address if above is less than 2 years:
City:
State:
ZIP Code:
Owned
Rented
Other
(circle one)
Monthly payment or rent:
How long?
EMPLOYMENT INFORMATION
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Pay rate: $____________ per
Position:
Hourly
Salary (Circle one)
hr
mo
yr (circle one)
Previous employer (if less than one year):
Address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Pay rate: $____________ per
Position:
Hourly
Salary
(Circle one)
hr
mo
yr (circle one)
Amounts currently held in:
______________ Checking ______________ Savings _____________Investment ______________Other
Name of a relative not residing with you:
relationship:
Address:
Phone:
City:
State:
ZIP Code:
CO-BORROWER INFORMATION, IF APPLICABLE
Name:
DL #/State:
Date of birth:
SSN:
Phone:
Current address:
City:
State:
ZIP Code:
Phone:
E-mail:
Fax:
Own
Rent
Other
(circle one)
Monthly payment or rent:
How long?
Previous address if above is less than 2 years:
City:
State:
ZIP Code:
Own
Rent
Other
(circle one)
Monthly payment or rent:
How long?
EMPLOYMENT INFORMATION
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly Salary
(Circle one)
Pay rate: $___________ per hr/ mo/yr (circle one)
Previous employer (if less than one year):
Address:
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly
Salary
(Circle one)
Pay rate: $___________ per hr/ mo/yr (circle one)
1
L OAN AP P L I C AT IO N W OR KS HE ET
APPLICANT INFORMATION
Name:
DL #/State:
Date of birth:
SSN:
Current Street Address:
City:
State:
ZIP Code:
Phone:
E-mail:
Fax:
Own
Rent
Other
(circle one)
Monthly payment or rent:
How long?
Previous address if above is less than 2 years:
City:
State:
ZIP Code:
Owned
Rented
Other
(circle one)
Monthly payment or rent:
How long?
EMPLOYMENT INFORMATION
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Pay rate: $____________ per
Position:
Hourly
Salary (Circle one)
hr
mo
yr (circle one)
Previous employer (if less than one year):
Address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Pay rate: $____________ per
Position:
Hourly
Salary
(Circle one)
hr
mo
yr (circle one)
Amounts currently held in:
______________ Checking ______________ Savings _____________Investment ______________Other
Name of a relative not residing with you:
relationship:
Address:
Phone:
City:
State:
ZIP Code:
CO-BORROWER INFORMATION, IF APPLICABLE
Name:
DL #/State:
Date of birth:
SSN:
Phone:
Current address:
City:
State:
ZIP Code:
Phone:
E-mail:
Fax:
Own
Rent
Other
(circle one)
Monthly payment or rent:
How long?
Previous address if above is less than 2 years:
City:
State:
ZIP Code:
Own
Rent
Other
(circle one)
Monthly payment or rent:
How long?
EMPLOYMENT INFORMATION
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly Salary
(Circle one)
Pay rate: $___________ per hr/ mo/yr (circle one)
Previous employer (if less than one year):
Address:
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly
Salary
(Circle one)
Pay rate: $___________ per hr/ mo/yr (circle one)
1
L OAN AP P L I C AT IO N W OR KS HE ET
REFERENCE # 1
Name:
Current address:
City:
State:
ZIP Code:
Phone #
Relation to you:
REFERENCE # 2
Name:
Current address:
City:
State:
ZIP Code:
Phone #
Relation to you:
LOAN INFORMATION
Have you ever defaulted on a student loan?
Yes
No
How long would you like the payments to run?
2yrs
3yrs
5yrs
10 yrs
15yrs
Would you like to defer the payments?
3 months
6 months
12 months
OTHER ASSETS OR SOURCES OF INCOME (ALIMONY/CHILD SUPPORT ETC.)
Description:
Amount per month or value
Description:
Amount per month or value
Comments:
SIGNATURE
Signature:
Date:
**ALL ITEMS IN BOLD ARE REQUIRED FIELDS**
2

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