Hebrew Free Loan Association Monthly Budget Form
Applicant’s name____________________________________________________ Date/___/___/
ITEM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
EXPENSE DESCRIPTION Groceries & Household Supplies Medical & Health Insurance Homeowners Insurance Automotive Insurance Life Insurance Disability Insurance Automobile Gas Automobile Repairs City Taxes Closing Child Care Children's Activities & Allowances Children's bus fare, school supplies, or lunches School Tuition Bus Fare Adult Spending Money (Lunches, etc.) Dry-cleaning % Laundry Dentist & Doctor Prescription & Medications Drug Store Items (Including cigarettes) Hair Care Gifts Recreations Newspapers & Magazines Contributions (religious or other) Home Heating Gas Electricity Phone Service Real Estate Taxes Water Sewage Mortgage/Rent Car Loans School Loans Cable TV Service Other Other Other Total Expenses per Month
AMOUNT
THE HEBREW FREE LOAN ASSOCIATION OF CLEVELAND DIRECT LOAN APPLICATION
THE OHIO LAWS AGAINST DISCRIMINATION REQUIRE THAT ALL CREDITORS MAKE CREDIT EQUALLY AVAILABLE TO ALL CREDIT WORTHY APPLICANTS, AND THAT CREDIT REPORTING AGENCIES MAINTAIN SEPARATE CREDIT HISTORIES ON EACH INDIVIDUAL UPON REQUEST. THE OHIO CIVIL RIGHTS COMMISSION ADMINISTERS COMPLIANCE WITH THIS LAW. DATE OF APPLICATION:__________________________________
PERSONAL
Amount of Loan: Loan Purpose: Date of Birth Driver’s License no. Social Security No.
Last Name Address City Previous Address City Home Telephone
First Name
M.I.
Birth name /AKA/Previous name
State
Zip
State Cell Phone
Zip Fax
Marital Status
Single
Married
Divorced
Separated
Widowed
Number of Persons in Household: Monthly Household Income: Number of Dependents & ages: Others providing income: Income Sources: Name & amount Net Gross
(Please list all Assets; Stocks, Bonds, Rental property, Bank Acc’ts, CD’s, etc)
Notice to Applicant: Your income from alimony, child support, or separate maintenance need not be revealed if you do not choose to have it considered in the basis for credit.
Occupation:
Employer Previous Employer
Employer Phone Number Employer Phone Number
Employed since Employed since
Referred By:
PLEASE COMPLETE BOTH SIDES
SPOUSE/CO-HABITANT/PARTNER
Spouse/Co-Habitant/Partner’s Name
Spouse/Co-Habitant/Partner’s Date of Birth
Spouse/Co-Habitant/Partner’s Social Security no.
Spouse/Co-Habitant/Partner’s Occupation
Spouse/Co-Habitant/Partner’s Employer
HOUSING
Own Monthly payment: If Owned: Purchase Price: Purchase Date: Current Value: Original Mortgage: Equity in home: Rent
OTHER DEBTS
(Please include: equity loans, personal loans, second mortgages,car loans, student loans, medical, etc...)
AUTOMOBILE
Own Lease
Make: Model: Year: Purchase Price: Monthly Payment::
Have you ever received a loan from HFLA?
Yes
No
If yes, please provide: amount, year, purpose, and loan number of previous loan:
The above information is for the purpose of obtaining credit and is warranted to be true. I agree to pay all bills upon receipt of statement or as otherwise expressly agreed. I hereby authorize the person of firm to whom this application is made, any credit bureau or other investigative agency employed by such person, to investigate the references herein listed or statements or other data obtained from me or from any other person pertaining to my credit and financial responsibility.
Signature of the Applicant Signature of the Applicant’s Spouse
For Office Use: Date recorded: Method Recorded: Loan Committee date: Loan Committee recommendations:
DATE
DATE
HEBREW FREE LOAN DIRECT LOAN APPLICATION
Guarantor Information
Date of Birth Guarantor’s Name
Applicant’s Name
Phone No.
Soc. Sec. No.
Address
Previous Address
Employer
Employer’s Address
Phone No.
Occupation
Job Take Home Pay
Employed How Long?
Previous Employer
Employed How Long?
$
Other Income
! Per Week ! Per Month Source(s) of Other Income and Assets (Bank Acc’ts, Stocks, Rent, Bonds, CD’s, Etc.)
$
Residence Monthly Instal.
NOTICE TO GUARANTOR: Your income from
Alimony, Child Support or Separate maintenance need not be revealed if you do not choose to have it considered in the basis for credit. Banking Reference
Mortgage Holder/Land Contract Holder/Landlord
! Owns ! Rents
Date Purchased
$
Purchase Price Original Mortgage Balance Due on Mortgage Current Value on Rl. Est.
$
Personal Reference
$
List of Debts of Guarantor
Date Made Loan Amount Terms
$
Last Paid
$
Balance Next Due
Name of Creditor
Type of Credit
The Above information is for the purpose of obtaining credit and is warranted to be true. I agree to pay all bills upon receipt of the statement or as otherwise expressly agreed. I hereby authorize the person or firm to whom this application is made, any credit bureau or other investigative agency employed by such person, to investigate the references herein listed or statements or other data obtained from me or from any other person pertaining to my credit and financial responsibility.
_____________________________________________________ Signature of Guarantor
THE HEBREW FREE LOAN ASSOCIATION
23300 Chagrin Boulevard Suite 204 Beachwood, Ohio 44122 216-378-9042
Loans Made For Worthy Purposes Regardless of Race or Creed
The Hebrew Free Loan Association is considering an application for an interest free loan on which you will be a co-signer on the promissory note. If the loan is approved, it will be conditioned on your responsibility to repay any part of the debt not paid by the borrower in the event the borrower defaults.
Approved by co-signer: