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Loan Application

Primary Applicant Information

First Name:

Last Name:

Social Security Number:

Date of Birth:

Email:

Phone Number:

Amount Requested:

Purpose For Loan:


Where do you live?
Home Address 1:

Home Address 2:

City:

State:

Zip Code:

Years At That Address:


If you have lived anywhere else in the last five years, enter that address below
Previous Address 1:

Previous Address 2:

City:

State:

Zip Code:

Years At That Address:


Employment Information
Name of Employer:

Position:

Net Pay:

Name of Supervisor:

Employer's Phone Number:


If you have worked anywhere else in the last five years, enter that information below
Name of Employer:

Position:

Net Pay:

Name of Supervisor:

Employer's Phone Number:


Vehicle information
Car Make:

Car Model:

Car Year:


If you have another vehicle, enter that information below
Secondary Car Make:

Secondary Car Model:

Secondary Car Year:


How Did You Hear About Us?:


If you have any other loans, list them below
Creditor 1:

Monthly Payment:

Creditor 2:

Monthly Payment:

Creditor 3:

Monthly Payment:

Creditor 4:

Monthly Payment:


If using a co-signer, enter their information below
Co-Signer Last Name:

Co-Signer First Name:

Co-Signer Birthday:

Co-Signer Home Address 1:

Co-Signer Home Address 2:

How Long at that Address?

Co-Signer Phone Number:

Relation to Applicant:

Co-Signer Employer:

Co-Signer Position:

Co-Signer Supervisor:

Co-Signer Employer Phone:

Co-Signer Net Pay:

Co-Signer SSN:


Notice Regarding Equal Credit Opportunity Act
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capability to enter into a binding contract): because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning is the Federal Trade Commission, 633 Indiana Avenue, NW, Washington, DC 20580.

Loan Application Declaration
The Applicant(s) by clicking Submit, having this 'Loan Application' to First Georgia Loan Company do hereby certify the following statements to be true and correct: the loan is sought on the basis of the credit worthiness of the undersigned applicant(s) and not in behalf of any other person; the collateral as described in the 'Loan Application' is the separate property of the undersigned person(s), except as otherwise stated in the Security Agreement, and said collateral is not owned jointly with any other person. We hereby authorize the person to whom this application is made, or any credit bureau or investigative agency employed by such person, to investigate the references herein listed or statements or other data obtained from us or from any other person pertaining to our credit and financial responsibility. We have read the Notice Regarding Equal Credit Opportunity Act as shown above.

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