Application of: _______________________ Loan No. ___________________________
HEBREW FREE LOAN SOCIETY OF PRINCETON/MERCER/BUCKS c/o Jewish Family & Children’s Service 707 Alexander Road, Suite 102 Princeton, New Jersey 08540 (609) 987-8100
GENERAL LOAN APPLICATION (please print) I. APPLICANT INFORMATION Name ____________________________________________________________ Social Security No. _________________________________________________ Date of Birth ________________________Country of Birth ________________ Home Address______________________________________________________ City/State/Zip______________________________________________________ How long at present address? __________Telephone Number ( ) ___________ Previous Address (within last _____years) _______________________________ Driver’s License No. _________________________ (please provide photocopy) U.S. Citizen Yes _____ No _____ In U.S. since _________________________ Marital Status (check one): ___Single ___Married ___Divorced ___Separated ___ Widow(er) Spouse’s Name (if applicable) ________________________________________ Spouse’s Social Security No. __________________________________________ Spouse’s Driver License No. __________________(please provide a photo copy) Dependents: Name 1.______________________ 2.______________________ 3.______________________ 4.______________________ Age ___ ___ ___ ___ Relationship ______________ ______________ ______________ ______________ Live at Home? ____________ ____________ ____________ ____________
Referred By: _______________________________________________________
II.
LOAN INFORMATION Amount Requested: $ __________________________ Purpose of Loan: ___________________________________________________ __________________________________________________________________ Prior Experience with Hebrew Free Loan Society (if any) ___________________ __________________________________________________________________
III.
EMPLOYMENT Applicant: Employer _______________________________Occupation_________________ Address __________________________________________________________ Telephone No. _____________________How long employed? ______________ Position __________________________Supervisor _______________________ Salary ___________________________ Spouse: Employer _______________________________Occupation_________________ Address __________________________________________________________ Telephone No. _____________________How long employed? ______________ Position __________________________Supervisor _______________________ Salary ___________________________
IV.
OTHER FINANCIAL INFORMATION Monthly Rental/Mortgage Payment $ _______________ Total Other Monthly Expenses Additional Monthly Income $ __________________ $ ______________________
Other Loans Outstanding (type & amount of loans) ________________________ __________________________________________________________________ Current Liquid Assets (bank accounts, certificates of deposit, securities, etc.) ========================================================== V. BANK INFORMATION Name of Bank/Branch ______________________ ______________________ Checking _______ _______ Savings ______ ______ Account No. (?) __________________ __________________
VI.
ADDITIONAL INFORMATION 1. Are there any extenuating circumstances affecting this potential loan of which we are not aware? _______________________________________________________________ _______________________________________________________________ 2. Have you ever co-signed a loan from the Hebrew Free Loan Society? Yes___ No___ For whom? _______________ When? _____________ 3. Have you co-signed any other loan? Yes ___ No ___ For whom? __________ 4. How did you hear of the Hebrew Free Loan Society? ____________________ _______________________________________________________________
All information acquired during loan processing will remain confidential and will not be disclosed to other individuals or agencies by the administrators of the Hebrew Free Loan Society. In conjunction with this Application, the undersigned hereby certifies/certify that the above statements which are submitted for the purpose of obtaining this loan is true, correction and complete. The Hebrew Free Loan Society of Princeton/Mercer/Bucks is authorized to make inquiries and gather such information that it feels is necessary and reasonable concerned statements made on this application. It is further agreed that the Hebrew Free Loan Society shall be promptly notified of any material changes in this information. Applicant Signature ___________________________________ Date _________ Spouse’s Signature ____________________________________ Date _________
OFFICE USE ONLY: Employer Verification: ______________________________________________ Disposition of Application: ___________________________________________