Christmas Loan Application

CHRISTMAS LOAN APPLICATION

Borrower Information

Account Number *

Loan Amount:

$1000

$1500

First Name *

Last Name *

Initial *

Present Address *

City *

ZIP Code *

Phone Number *

Social Security Number *

Birth Date *

Christmas Loan Application (continued)

Employment Information

Employer *

Payment Frequency:

Weekly

Bi-weekly

Monthly

References

Reference Name *

Reference Address *

Phone *

Reference Name *

Reference Address *

Phone *

Checking this box indicates my signature to submit this application.

Thank You