1 Contact Info 2 Type of Requested Credit 3 Applicant Information 4 Asset Owned 5 Outstanding Debts 6 Employment Information 7 Other Obligations 8 Property Infomation (if secured) 9 Marital Status 10 Signers 11 Privacy Policy How can we contact you? 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 Type of Requested Credit Please answer all the questions. Application Date * Required Amount * Required $ Number of Months * Required Select 180 Months First Payment Date Required Financing Type * Required Select New Refinance Modification Credit Type * Required Select Line Of Credit Loan Sale Lease Loan Purpose * Required Select Agricultural Business Consumer Security of Credit * Required Select Unsecured Secured Proceeds of Credit to Be Used For. * Required Select To purchase property that will secure your credit To purchase property that is a residential dwelling and not real estate To finance home improvements to a residential dwelling Other: Home Equity Line of Credit Which type of credit are you applying for? * Required Select Individual Credit- Relying solely on your income & assets Individual Credit- Your & other sources of income/assets Joint Credit- Applicant Information Please complete the following questions. Do you own or rent your current residence? * Required Select Own Rent How many years have you lived at your current residence? * Required Previous Address Required Did you own or rent your previous residence? Required Select Own Rent How many years did you live at your previous residence? Required Number of Dependents * Required Ages of dependents Required Second Phone Required Nearest Relative Not Living with You? * Required Nearest Relative's Address Required Nearest Relative's Phone Number * Required Relationship to Us? * Required Select None Employee Insider Have you ever received credit from us? * Required Select Yes No Office/Branch Required Government ID Type * Required Select Drivers License Passport State Issued ID Other Government ID Number * Required Government ID Issued By (State) * Required Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Government ID Issue Date * Required Government ID Expiration Date * Required Co-Applicant: Do you own or rent your current residence? Required Select Own Rent Co-Applicant: How many years have you lived at your current residence? Required Co-Applicant: Previous Address Required Co-Applicant: Did you own or rent your previous residence? Required Select Own Rent Co-Applicant: How many years did you live at your previous residence? Required Co-Applicant: Number of Dependents Required Co-Applicant: Ages of dependents Required Co-Applicant: Second Phone Required Co-Applicant: Nearest relative not living with you? Required Co-Applicant: Nearest Relative's Address Required Co-Applicant: Nearest Relative's Phone Number Required Co-Applicant: Relationship to Us? Required Select None Employee Insider Co-Applicant: Have you ever received credit from us? Required Select Yes No Co-Applicant: Office/Branch Required Co-Applicant: Government ID Type Required Select Drivers License Passport State Issued ID Other Co-Applicant: Government ID Number Required Co-Applicant: Government ID Issued Date Required Co-Applicant: Government ID Issued By (State) Required Co-Applicant: Government ID Expiration Date Required Asset Owned If the "Joint Applicant" or "Other Party" Sections were completed, this Section should be completed by giving information about both the Applicant and the Joint Applicant or Other Party, if applicable Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 2. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 3. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 4. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 5. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 6. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 7. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 8. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 9. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 10. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 11. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required 12. Type of Asset or Description Required Account Number Required Current Market Value Required $ Remaining Balance of Lien Required $ Asset Owner's Name Required Outstanding Debts This section should be charge accounts, installment contracts, credit cards, rent, mortgages and other obligations. If you rent, who is your landlord? Required Monthly Rent Payment Required $ Debtor's Name/Leaseholder Required Are you past due on your rent? Required Select Yes No If you own your home, who is your Mortgage/Lien Holder? Required Type of Debt or Account Number Required Original Mortgage Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Is your mortgage payment past due? Required Select Yes No 1. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No 2. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No 3. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No 4. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No 5. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No 6. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No 7. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No 8. Creditor Name Required Type of Debt or Account Number Required Original Amount Required $ Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes 9. Creditor Name Required Type of Debt or Account Number Required Original Amount Required Present Balance Required $ Monthly Payment Required $ Debtor's Name Required Past Due? Required Select Yes No Please List Any Credit Reference: Credit Reference Name. Required Original Amount Borrowed Required $ Date Paid in Full Required Credit Reference Name Required Original Amount Borrowed Required $ Date Paid in Full Required Credit Reference Name Required Original Amount Borrowed Required $ Date Paid in Full Required Employment Information Please enter your employment infomation Name of Employer * Required Address of Employer Required Manager Required Phone Number Required Gross Monthly Income * Required $ Position/Title Required Current, Previous or Self? * Required Select Current Previous Self Number of Years on the Job * Required If worked at your current job less than 2 years, what is the name of your previous employer? Required Address of Previous Employer Required Previous Manager Required Phone Number of Previous Employer Required Previous Gross Monthly Income Required $ Previous Position/Title Required Number of Years on the Job Required Current, Previous or Self? Required Select Current Previous Self Do you have more than one employer? Required Select Yes No Name of Employer Required Address of Employer Required Manager Required Phone Number Required Gross Monthly Income Required $ Position/Title Required Number of Years on the Job Required Current, Previous or Self? Required Select Current Previous Self Alimony, child support, or seperate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Required Select Court Order Written Agreement Oral Understanding N/A If you earn any other income monthly, please list the amount. Required $ Where do you receive this income from? Required Is any income (ie, Assets, Employment, Other Income) likely to be reduced before the credit is paid off? Required Select Yes No If answered yes to the previous question, please explain Required Co-Applicant: Name of Employer Required Co-Applicant: Address of Employer Required Co-Applicant: Manager Required Co-Applicant: Phone Number Required Co-Applicant: Gross Monthly Income Required $ Co-Applicant: Position/Title Required Co-Applicant: Number of Years on the Job Required Co-Applicant: Current, Previous or Self? Required Select Current Previous Self Co-Applicant: If worked at your current job less than 2 years, what is the name of your previous employer? Required Co-Applicant: Address of Previous Employer Required Co-Applicant: Previous Manager Required Co-Applicant: Phone Number of Previous Employer Required Co-Applicant: Previous Gross Monthly Income Required $ Co-Applicant: Previous Position/Title Required Co-Applicant: Number of Years on the Job Required Co-Applicant: Current, Previous or Self? Required Select Current Previous Self Co-Applicant: Do you have more than one employer? Required Select Yes No Co-Applicant: Name of Employer Required Co-Applicant: Address of Employer Required Co-Applicant: Manager Required Co-Applicant: Phone Number Required Co-Applicant: Gross Monthly Income Required $ Co-Applicant: Position/Title Required Co-Applicant: Number of Years on the Job Required Co-Applicant: Current, Previous or Self? Required Select Current Previous Self Co-Applicant: Alimony, child support, or seperate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Required Select Court Order Written Agreement Oral Understanding N/A Co-Applicant: If you earn any other income monthly, please list the amount. Required $ Co-Applicant: Where do you receive this income from? Required Co-Applicant: Is any income (ie, Assets, Employment, Other Income) likely to be reduced before the credit is paid off? Required Select Yes No If answered yes to the previous question, please explain Required Other Obligations Please answer to the best of your ability. Are you a co-maker, endorser, co-signer, surety, or guarantor on any loan, contract or other obligations? * Required Select Yes No Amount Required $ For Whom? Required To Whom? Required Are there any unsatisfied judgements against you? * Required Select Yes No Amount per month Required $ To whom? Required Have you been declared bankrupt in the last 10 years? * Required Select Yes No Where (State)? Required Year Required Are you obligated to make Alimony, Support, or Maintenance Payments? * Required Select Yes No Amount per month Required $ To whom Required Co-Applicant: Are you a co-maker, endorser, co-signer, surety, or guarantor on any loan, contract or other obligations? Required Select Yes No Co-Applicant: Amount Required $ Co-Applicant: For Whom? Required Co-Applicant: To Whom? Required Co-Applicant: Are there any unsatisfied judgements against you? Required Select Yes No Co-Applicant: Amount per month Required $ Co-Applicant: To whom? Required Co-Applicant: Have you been declared bankrupt in the last 10 years? Required Select Yes No Co-Applicant: Where (State)? Required Co-Applicant: Year Required Co-Applicant: Are you obligated to make Alimony, Support, or Maintenance Payments? Required Select Yes No Co-Applicant: Amount per month Required $ Co-Applicant: To whom Required Property Infomation (if secured) Please answer the following questions Property Type * Required Select 1-4 Residential Property Property Description (beds, bath sq. ft., legal description) * Required Property Description: Please choose an option. * Required Select Residential Dwelling Homestead Property Property Location and Address * Required Primary Use of Property * Required Select Agricultural Business Consumer Property Owner(s) name & Addresses * Required Marital Status Leave Blank unless: (1) the credit will be secured or (2) you reside in a community property state, or (3) you are relying on property, state, as a basis for repayment Applicant Required Select Married Separated Unmarried (including single, divorced, widowed) Joint Applicant or Other Party Required Select Married Separated Unmarried (including single, divorced, widowed) Please list any additional information or explanations here: Required Additional Signers Create and assign signers for signature roles. Add Signer Borrower * Required Select a signer None/Not Applicable Co-Borrower Borrower * Required Select a signer None/Not Applicable All Signers Privacy Policy Please read and accept the privacy policy to continue. Accept Privacy Policy You're done! Thank you for completing your application! You can now begin signing your closing documents. Thank you for completing your application!Your financial institution is reviewing your application and will contact you for the next steps.You can now safely close your browser window or tab. Thank you for your submission! Your financial institution will contact you for the next steps.You can now safely close your browser window or tab. © Copyright 2024 Epic River Financial, Inc. All rights reserved. Version 24.2.2.5