Consumer Loan Inquiry

* indicates a required field

Is this an individual or joint loan?

Individual
Joint

Primary Borrower's Information

*Name (First M. Last):
*Birthdate (mm/dd/yyyy):
*SSN:
*Education Level:
*Number of Dependents:
Ages of Dependents: #1 #2
#3 #4
#5 #6
*Home Phone Number: ( ) -
*Email Address:

Present Address

*Physical Address
*City, State
*County, Zip
*Mailing Address
*City, State
County, Zip
Former Address (If at present address less than 2 years)
Street:
City, State:	,
Zip-Plus4:	-

Current Employer
*Employer:
*Job title:
*Street Address:
*City, State:	,
*Zip-Plus4:	-
*Work Phone Number:	( ) - ext.
Former Employer (If at present job less than 2 years)
Employer:
Job title:
Street Address:
City, State:	,
Zip-Plus4:	-
Work Phone Number:	( ) - ext.

Co-Borrower's Information

(joint applicant or cosigner only)

*Name (First M. Last):
*Birthdate (mm/dd/yyyy):
*SSN:
*Education Level:
*Number of Dependents:
Ages of Dependents: #1 #2
#3 #4
#5 #6
*Home Phone Number: ( ) -

/

Present Address

*Physical Address:
*City, State, Zip: ,

*County:

*Mailing Address:

*City, State, Zip: ,

*County:

Former Address
(If at present address less than 2 years)

Street Address:
City, State: ,
Zip-Plus4: -

Current Employer

*Employer:
*Job title:
*Street Address:
*City, State: ,
*Zip-Plus4: -
*Work Phone Number: ( ) - ext.

Former Employer
(If at present job less than 2 years)

Employer:
Job title:
Street Address:
City, State: ,
Zip-Plus4: -
Work Phone Number: ( ) - ext.

Monthly Income
	Borrower	Co-Borrower
*Base Employ Income:
*Overtime/Bonus:
*Dividends/Interest:
*Rental Income:
*Other:
*Total:
Note: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan.

Property and Loan Info
*Amount Requested:	$
*Collateral:
Purpose of Loan:	Auto Loan	Line of Credit
	Consolidation
	Other

Assets and Liabilities

	ASSETS	VALUES
Checking accounts:

Stock, Bonds, or Mutuals:

Real Estate:

Retirement accounts:

Autos:

Other:

Total Assets

	LIABILITIES	BALANCE
Real Estate:


Autos:


Credit Cards:


Others:

Total Liabilities
Net Worth (assets - liabilities)

Borrower	Co-Borrower
Yes No	Yes No	Are there any judgments against you?
Yes No	Yes No	Have you been declared bankrupt within the past 7 years?
Yes No	Yes No	Have you had property foreclosed upon or given title/deed in lieu thereof in the last 7 years?
Yes No	Yes No	Are you a party to a law suit?
Yes No	Yes No	Are you obligated to pay alimony, child support, or separate maintenance?
Yes No	Yes No	Is any of the down payment borrowed?
Yes No	Yes No	Are you a co-maker or endorser on a note?

*Name (First M. Last):
*Birthdate (mm/dd/yyyy):
*SSN:
*Education Level:
*Number of Dependents:
Ages of Dependents:	#1 #2 #3 #4 #5 #6
*Home Phone Number:	( ) -
*Email Address:

Present Address
*Physical Address:
*City, State, Zip:	,
*County:
*Mailing Address:
*City, State, Zip:	,
*County:
Former Address (If at present address less than 2 years)
Street Address:
City, State:	,
Zip-Plus4:	-
Current Employer
*Employer:
*Job title:
*Street Address:
*City, State:	,
*Zip-Plus4:	-
*Work Phone Number:	( ) - ext.
Former Employer (If at present job less than 2 years)
Employer:
Job title:
Street Address:
City, State:	,
Zip-Plus4:	-
Work Phone Number:	( ) - ext.