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Community Lending Works#12498

Loan Application Form

Date Of Application

Minimum amount is $300, and maximum amount is $2,500.

Maximum amount is $30,000

Select Loan Application Type *

Express Personal Loan

Credit Builder Application

Rental Deposit Application

Auto Loan Application

Enter Requested Loan Amount

Select Amount

$300

$600

$1000

Enter Requested Auto Loan Amount

Targeted Monthly Payment Amount

Please note: If your loan request is approved, loan funds will be disbursed at the completion of the loan term.

First Name *

Middle Name

Last Name *

SSN Or ITIN *

Birth Date *

All applicants must be 18 years or older

Do You Have An Email Address? *

Yes

Email Address *

Housing Expense per month?

Total # Of People In Your Household

Do You? *

Rent

Own

Other

Driver's License Number/ID *

Phone Type *

Main Phone *

Phone Type

Secondary Phone

Other Description

Street Number *

Street Name *

Street Type

Apt #

City *

State (OR Only)

Zip *

County *

How Many Addresses Have You Had In The Last 2 Years *

Are you in an active bankruptcy case? *

Yes

NOTE: Having a bankruptcy does not automatically disqualify you from being approved for credit.

Is There A Co-applicant?

Yes

Have You Selected A Car Already?

Yes

Year, Make, And Model

Is There A Planned Down Payment?

Yes

Down Payment Amount

Co-applicant Name

Co-applicant Address

Co-applicant SSN

Co-applicant Date Of Birth

NOTE: Add co-applicant's income to sources of income.

Enter all sources of income

Source Of Income?

Amount paid monthly

If You Cannot Provide Your Wage As A Monthly Amount, Please Explain Why

Note: By submitting this application you are attesting that the above income is accurate.

When Would You Like Your Payment Due Date To Be? *

5th

15th

25th

What Bank Accounts Do You Have?

Checking

Savings

Both

None

Do You Have A Property Identified?

Yes

Scheduled Move In Date

Property Address (street, City, State, Zip)

Landlord Contact Information

These Funds Are To Be Utilized For A Housing Deposit

Yes

Attachments

We require proof of income. Please attach proof of ALL sources of income.

Proof Of Income. Please Select All That Apply

Current Pay stub(s) - 30 days

SSI/SSDI Award Letter or Bank Statement

Latest Tax Return (if self-employed)

Retirement/Pension Statement

Demographics

The following information is used for grant purposes only and will have NO bearing on your credit application. You can elect to not participate if you so choose.

Which Gender Do You Identify With?

Family Status?

Do You Identify As LGBTQ?

Yes

Prefer not to answer

Please make selections in both Race and Ethnicity: (select as many as apply)

Single Race:

Multi-Race:

Ethnicity:

Are You A U.S. Veteran?

Yes

Prefer not to answer

Are You Receiving Services For A Disability?

Yes

Prefer not to answer

How Did You Hear About Us?

Event/Expo

Professional Referral

DEVNW/Class/Counseling

Referred by family/friend

Other

Professional Referral

Family Or Friend

Other

How Much Is This Loan Going To Help You Out Of A Difficult Situation?

How Is This Loan Going To Help You? Please Select All That Apply:

Housing stability

Mental health

Physical health

Safety

Ease financial burden

Improve financial independence

Would you like to opt out of our demographic data collection? *

Yes

Confirmation and Signature

By signing below you understand and agree that you are providing instructions to Community LendingWorks under the Fair Credit Reporting Act (“FCRA”) to access information from your personal credit profile or other information from one or more consumer reporting agencies such as Equifax. This authorization for Community LendingWorks allows them to obtain such information solely to conduct a pre-qualification for credit. By proceeding, we will initiate a credit pull of your credit. We reserve the right to initiate a “soft pull” of your credit in the future, this “soft pull” will not affect your credit score.

Applicant Signature *

Attachments

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Community Lending Works#12498

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