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Let's start with a little information about you.

First Name * Required

Middle Name Required

Last Name * Required

Email Address * Required

Confirm Email Address * Required

Address Line 1 * Required

Address Line 2

City * Required

State * Required Please select a state Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Northern Mariana Islands Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington U.S. Virgin Islands West Virginia Wisconsin Wyoming

Zip * Required

Date of Birth *Invalid Date

Social Security Number *Required

Phone Number *Required By providing the phone number, you are opting in to receive SMS updates regarding your documents and transaction status. Epic River does not charge for SMS messaging; however, message & data rates may apply. Contact your mobile carrier for information.

Insurance Information

Please answer all questions

Are you applying for Joint or Individual Account * Required Select Individual Joint

Amount of Loan Request * Required

$

Specific Purpose Of Loan * Required

Requested payment term * Required

Proposed Collateral * Required

Insurance Agent and Contact * Required

Applicant Information

Please answer all relevant question for Applicant

What is Your Place of Birth * Required

Mothers Maiden Name * Required

Cell If Different Required

Street Address if Different to Mailing Address Required

Do you agree to receive Text and Email notifications * Required Select Yes No

Have you been declared bankrupt in the last 7 years * Required Select Yes No

If Yes, enter date * Required

Have you had a car or other merchandise repossessed? * Required Select Yes No

If Yes by whom and when: * Required

Please select your preference regarding voluntary insurance * Required Select Credit Life Credit Disability Credit Life & Credit Disability None

Name and Address of Closest Relative not living with you * Required

Phone No. of Closest relative * Required

Employment for Applicant

Please answer all the questions.

Employer * Required

Length of Time with Current Employer * Required

Occupation If Retired please list previous Occupation * Required

Take home pay per month * Required

$

Other Income Source (Note: Alimony, child support and separate maintenance payment income need not be revealed if you do not wish to have it considered as a basis for repaying this credit) Required

Amount of other income Required

$

Other Income Time period (Per month year etc) Required

Are you subject to backup withholding * Required Select Yes No

Co-Applicant

Please complete if there is a Co-Applicant

Place of Birth * Required

Mother Maiden Name * Required

Cell Phone if different Required

Street Address If Different Required

Do you agree to receive Text and Email notifications * Required Select Yes No

Name of Closest Relative not living with you * Required

Phone Number of Closest Relative * Required

Please select your preference regarding voluntary insurance * Required Select Credit Life Credit Disability Credit Life & Credit Disability None

Co-Applicant Employment

Please complete if there is a Co-Applicant

Employers Name * Required

Length of time at current employer * Required

Occupation If Retired please list previous Occupation * Required

Take Home Pay per Month * Required

$

Other Income Source (Note: Alimony, child support and separate maintenance payment income need not be revealed if you do not wish to have it considered as a basis for repaying this credit) Required

Amount of other income source Required

$

Other Income Time period (Per month year etc) Required

Are you subject to backup withholding * Required Select Yes No

Statement of financial Condition Assets

Please answer all the questions.

TOTAL CASH/DEPOSITS Required

$

Stocks and Bonds Total Required

$

Tax Refund Due Required

$

Insurance Cash Value Required

$

Accounts Receivable Required

$

Real Estate Assets

Please answer all the questions.

Residence Required

$

Unimproved Land Required

$

Income Properties Required

$

Autos and Other Titled Assets

Please answer all the questions.

Titled 1 Description Required

Titled 1 Value Required

$

Titled 2 Description Required

Titled 2 Value Required

$

Titled 3 Description Required

Titled 3 Value Required

$

Titled 4 Description Required

Titled 4 Value Required

$

Other Assets

Please answer all the questions.

Asset 1 Description Required

Asset 1 Value Required

$

Asset 2 Description Required

Asset 2 Value Required

$

Asset 3 Description Required

Asset 3 Value Required

$

Asset 4 Description Required

Asset 4 Value Required

$

Liabilities

Primary Residence

LANDLORD or MORTGAGE HOLDER Name Required

Landholder/ Mortgage Holder Required Select Landholder Mortgage

Payment Amount Required

$

Balance Required

$

Liability 1

Please answer all the questions.

Payable to Required

Secured By Required

Payment Amount Required

$

Balance Required

$

Liability 2

Please answer all the questions.

Payable to Required

Secured by Required

Payment Amount Required

$

Balance Required

$

Liability 3

Please answer all the questions.

Payable to Required

Secured by Required

Payment amount Required

$

Balance Required

$

Liability 4

Please answer all the questions.

Payable to Required

Secured by Required

Payment Amount Required

$

Balance Required

$

Liability 5

Please answer all the questions.

Payable to Required

Secured by Required

Payment Amount Required

$

Balance Required

$

Liability 6

Please answer all the questions.

Payable to Required

Secured by Required

Payment Amount Required

$

Balance Required

$

Liability 7

Please answer all the questions.

Payable to Required

Secured by Required

Payment Amount Required

$

Balance Required

$

Liability 8

Please answer all the questions.

Payable to Required

Secured by Required

Payment Amount Required

$

Balance Required

$

Liability 9

Please answer all the questions.

Payable to Required

Secured by Required

Payment Amount Required

$

Balance Required

$

Additional Signers

Create and assign signers for signature roles.

  Add Signer

Applicant * Required Select a signer None/Not Applicable

Co-Applicant * Required Select a signer None/Not Applicable

All Signers

Privacy Policy

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