Loan Application Loan Information Requested loan amount $ Term 3-month 6-month 1-year Purpose of loan Are you willing to give collateral for your loan? Yes No If yes, please describe collateral item (value should be equal to or greater than the amount you're borrowing) Referred By Personal Information Name First Name Last Name Phone (###) ### #### Email Date MM DD YYYY Identification Home address Address 1 Address 2 City State/Province Zip/Postal Code Country Type of Residence Owned Rent Other How many years have you been living in this residence? 0-1 years 1-2 years 3-4 years 5+ years Monthly Rent/Mortgage $ Monthly vehicle loan payment $ Monthly credit card payment $ Other expenses (Cell phone bill, gas, etc.) $ Employment Information Job Position/Title Company Name Years of Experience 0-1 years 1-2 years 3-4 years 5+ years Monthly Gross Income $ Other income (Second Job, EI, etc.) $ Total monthly income $ Company Address Address 1 Address 2 City State/Province Zip/Postal Code Country Company Phone (###) ### #### Thank you!
