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?


    Applicant Name on ID

    First Name

    Last Name

    Applicant ID Type

    Driver LicenseState Issued IDPassportMilitary ID

    ID Number


    ID Issue Date

    ID Expiration Date

    Applicant Phone

    (Area Code) 123-1234



    Birth Date




    Current Address

    Street Address

    Street Address Line 2


    State / Province

    Postal / Zip Code

    How Long Have You Lived in Your Given Address?

    0-1 Year1-2 Years3-4 Years5+ Years

    Employer Name


    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.


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


    Applicant Signature