Loan application form

    Reference Name



    First Name



    Last Name
    Account Number
    Amount Requested*
    Loan Term*
    3-12 Months18-24 Months36 Months60 Months120 Months
    Type of Improvement*
    Property Type*

    PRIMARY Applicant

    Do You Wish to Add a Co Applicant?
    YesNo
    Applicant Name on ID



    First Name



    Last Name
    Applicant ID Type
    Driver LicenseState Issued IDPassportMilitary ID

    ID Number
    State
    ID Issue Date
    ID Expiration Date
    Applicant Phone



    (Area Code) 123-1234
    E-mail
    SSN
    Birth Date


    Month


    Day



    Year
    Current Address


    Street Address


    Street Address Line 2


    City


    State / Province


    Postal / Zip Code
    How Long Have You Lived in Your Given Address?
    0-1 Year1-2 Years3-4 Years5+ Years
    Employer Name
    Occupation
    Years of Experience
    0-1 Year1-2 Years3-4 Years5+ Years
    Gross Monthly Income


    (You do not have to use income from Alimony, child support or maintenance unless you
    want it considered for this loan)
    Source of Other Income
    Monthly Rent/Mortgage

    By signing this application, I authorize 3H Roofing to process my credit application using all of the information I have provided. I hereby consent to sharing this information with interested third parties, including dealers and lending
    institutions that accept this application. I affirm that the information I have submitted is complete and truthful. I authorize you to make inquiries you consider necessary in evaluating my application and, subsequently, for purposes
    of reviewing, maintaining or collecting on my account.

    YES

    I here by agree that the information given is true, accurate and complete as of the date of this application submission.

    YES
    Applicant Signature
    Comments