Loans for All Reasons - Inquiry

Indicates a required field *

*Type of Loan:
*Approximate Amount of Loan:

Individual Credit

Check here if you are applying for individual credit. This means you are applying in your own name and are relying on your own income (and assets), NOT those of another person as the basis for repayment.

Complete only the applicant information.

Joint Credit

Check here if you are applying for joint credit. This means you are applying for credit with another person and will be relying on your joint income (and assets) as the basis for repayment.

Complete both the applicant information and the co-applicant information.

APPLICANT INFORMATION

*Applicant:
*Address:
*City, State, Zip:
*Applicant's Social Security Number:
*Date of Birth:
*Daytime Phone:
*Evening Phone:
E-mail Address:
*Applicant's Employment:
*Monthly Gross Income:

OPTIONAL INCOME**

Alimony:
Support:

**Alimony or child support income is optional information and need not be revealed if the applicant does not choose to rely on such income in applying for credit.

CO-APPLICANT INFORMATION

Co-Applicant:
Co-Applicant's Address:
City, State, Zip:
Co-Applicant's Social Security Number:
Date of Birth:
Daytime Phone:
Evening Phone:
E-mail Address:
Co-Applicant's Employment:
Monthly Gross Income:

OPTIONAL INCOME**

Alimony:
Support:

**Alimony or child support income is optional information and need not be revealed if the applicant does not choose to rely on such income in applying for credit.

*I/We certify that everything stated in this inquiry is correct. By submitting this form, I/We authorize VALUE FINANCE to have a consumer credit report prepared on me/us for the purpose of evaluating this inquiry for the loan.