Loan Application
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What type of loan are you interested in?
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How did you hear about us? *
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You first, middle, and last name: *
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Enter your social security number.
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Enter your date of birth:
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You spouse's first, middle, and last name? *
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If you have a cosigner, enter his/her full name:
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Enter your current address. We are only able to help customers who reside in the state of Ohio, U.S.A.. *
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How many months have lived at this location? *
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Please, enter your Home telephone number. *
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Please, enter your Cell. phone number. *
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Please, enter your E-Mail address. *
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Indicate below your living arrangements. *
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Please, indicate what type of account you have: *
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I have a
checking account
I have a
savings account
I don't have a checking or savings account
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If you have a checking account, how many months has it been open? *
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If you have a savings account, how many months has it been open? *
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What is your current Employer's name? *
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What is your current employer's address? *
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What is your employer's telephone number? *
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How long have your been employed with this employer?
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Is this a full-time job? *
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Are you working through a Temp. agency? *
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How often do you get paid?
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What is your average take home pay each payday?
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Are you self employed? *
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If you are not employed, please, state your source of income AND the amount of income that you receive per month.
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Are you in the process of filing for bankruptcy OR are you applying for this loan with the intent of filing for bankruptcy during the term of
this loan? *
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Are you a member of the armed forces on active duty, or are you a dependent of a member of the armed forces on active duty, or have you
received financial support, within the last 6 months, form a member of the armed forces on active duty? *
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Please, enter a reference's full name, city and state of residence, and day time phone number. Reference must be a relative.
*
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Please, indicate your relationship to the first reference. *
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Please, enter a reference's full name, city and state of residence, and day time phone number. Reference must be a relative.
*
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Please, indicate your relationship to the second reference. *
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Please, enter a third reference's full name, city and state of residence, and day time phone number. Reference must be a relative.
*
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Please, indicate your relationship to the third reference. *
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Please, enter a third reference's full name, city and state of residence, and day time phone number. Reference can be a close
friend. *
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Please, indicate your relationship to the fourth reference. *
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Please, enter a third reference's full name, city and state of residence, and day time phone number. Reference can be a close
friend. *
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Please, indicate your relationship to the fifth reference. *
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What is your total average monthly expense for rent/mortgage, electric, gas, water, telephone, food, & gasoline, combined:
*
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Indicate the loan amount desired, the number of months that you would like to pay the debt, and the monthly amount that you would like to pay
for the loan: *
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If you own any vehicle free of liens and debt that could be used as security for a loan, please, indicate the vehicle's VIN and
Mileage
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If you need us to finance a vehicle, indicate the dealership's or private party's name, sales person's name, and telephone:
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If you need us to finance a vehicle, please, indicate the VIN and Mileage of the vehicle that you would like us to finance.
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Please, use this space to let us know any comments or questions that you may have:
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Please, state the reason for wanting this loan. *
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Choose below the branch to which you would like this application to be sent? *
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By printing my name below, I, hereby authorize America’s Loan Company, to process my information through any number of credit reporting
agencies to obtain credit reports that will be used to determine my eligibility for a loan and as needed by the company *
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Please, enter today's date as the date of your application: *
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