APPLICATION FOR SECURED CREDIT ( Retired Military )
Amount of Loan Requested:
$200.00
$300.00 $400.00
$500.00 $600.00
$700.00 $800.00
$900.00 $1000.00
$1500.00 $2000.00
$3000.00
Purpose of Loan:
Name ( Last, First, Middle ):
Social Security Number:
Date of Birth:
E-mail Address:
Residental Address ( RR#, Street, Apt #, City, State & Zipcode / APO or FPO ):
Do You Rent or Own?:
Landlord Name (verify rent):
Landlord Phone #:
Employer:
Employer Address ( RR#, Street, Apt #, City, State & Zipcode / APO or FPO ):
Personnel Office Phone # (verify employment):
Home Phone Number:
Work Phone Number ( Commercial Not DSN ):
Facimile (FAX) Number:
Supervisor Name:
Supervisor Phone ( Commerical, No DSN ):
Number of Dependents:
Do you have a checking account?
Are you willing to open an allotment with us?
What is your monthly retirement take home ( Net ) Pay?
What is your monthly take home ( Net minus Retirement ) Pay?
Other Income Amount / Source: ( Alimony, child support, separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.)
Do you pay child support or alimony?
Have you ever filed for bankruptcy?
Bankruptcy Discharge Date ( Month/Year ):
COLLATERAL AND MONTHLY EXPENSES SHEET
In order to process your loan, we must have sufficient collateral to cover the loan. If you do not list collateral and provide the necessary information regarding the collateral, we won't be able to process your application.Our general collateral guidelines for small loans are as follows:
$100.00 to $300.00 requires personal property such as electronic equipment, musical instruments, sports equipment, power tools, lawn power tools, camera equipment. We use only property authorized by the Federal Trade Commission Regulation Rule, Title 16, Code of Federal Regulations, Sec 411, 1 (d, household goods as defined in said rule are listed only when the security interest is to secure, the purchase, price of goods being purchased. Household goods are defined as: Clothing, furniture, appliances, one radio and one television, linens, crockery, kitchenware and personal effects (including wedding rings). The term does not include, works of art, electronic entertainment equipment (except one television and one radio), antiques and jewelry (except wedding rings).
Item: Item: Item: Item:
Yr. Bought: Yr. Bought: Yr. Bought: Yr. Bought:
Serial #: Serial #: Serial #: Serial #:
Value: Value: Value: Value:
Vehicle Information ( Make, Model, Year, VIN# and 1st Lienholder ):
References:
Name:
Monthly Expenses:
Rent:
Phone:
Car:
Child Care:
List Allotments and Who Payed To:
Applicant(s) having first read this application, hereby executes same on the application date shown above, certifies that applicant(s) is the legal age to contract and that all of the above statements are true and complete and are made for the purpose of obtaining the credit applied for, warrants that the above statements fully represents applicant(s) income relied upon as the basis of repayment of the credit and total indebtedness, authorizes lender to communicate with applicant(s) or any person or corporation or governmental agency in connection with and during the pendency of this application or of any credit granted, for the purposes of investigation of the references or statements listed above or other data obtained from applicant or for purposes of extension or review or collection of said credit granted and any further credit extension or solicitation, UNDERSTANDS THAT THE PURCHASE OF CREDIT LIFE AND/OR CREDIT DISABILITY INSURANCE is not required by Lender to obtain loan, understands that Lender must notify an applicant within 30 days as to approval or rejection of the application and can request Lender's reasons for the action taken.
