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Express LOC_____ St. Louis County Home Improvement______ 80% Loan

100% USDA _____ Hard Money Loan _____ Other ________________________

Loan Application Information

Requested Loan Amount (if known):

Applicant Information
First Name*

Middle Initial

Last Name*

Date of Birth (mm/dd/yyyy)

/
Social Security Number*

Home Phone

Applicant Street Address* (Physical address required. No P.O. Boxes)

Suite/Apt#

City*

State*

Mobile Phone

Zip Code*

Email Address (if you provide an email address, Green Sky may use it to contact you about products, services, special offers and other promotions)
Employer*

Years on the Job*

Employer Phone Number*

If Applicant is retired, enter Retired in the Employer field, enter 0 in the years on Job field and enter the Applicants home phone number.
If Applicant is unemployed, enter Unemployed in the Employer field, enter 0 in the Years on the Job field and enter the Applicants home phone number.

Income

Alimony, child support or separate maintenance payments need not be revealed if you do not wish to have them considered as a basis for repaying the loan. Married Wisconsin Residents: Combine you and your spouses information once.

Applicants Gross MONTHLY Income ($)*

Other Gross MONTHLY Income ($)*

Examples: monthly salary (before taxes) alimony, child

support, investment income, social security, etc.

Examples: Co-Applicant and/or spousal income (before taxes),

alimony, child support, investment income, social security, etc.

Co-Applicant Information
First Name*

If completed below, Applicant and Co-Applicant intend to apply for joint credit.
Last Name*
Date of Birth (mm/dd/yyyy)

Middle Initial

/
Social Security Number*

Home Phone

Co-Applicant Street Address* (Physical address required. No P.O. Boxes)

Mobile Phone

Suite/Apt#

City*

State*

Zip Code*

Email Address (if you provide an email address, Green Sky may use it to contact you about products, services, special offers and other promotions)
Employer*

Years on the Job*

Employer Phone Number*

If Co-Applicant is retired, enter Retired in the Employer field, enter 0 in the years on Job field and enter the Applicants home phone number.
If Co-Applicant is unemployed, enter Unemployed in the Employer field, enter 0 in the Years on the Job field and enter the Applicants home phone number.

Applicant Signature
X________________________________________
Applicants Signature

Please provide a government issued

picture ID to the Associate/Contractor.

___________________
Date

Co-Applicant Signature
X________________________________________

Please provide a government issued

picture ID to the Associate/Contractor.

___________________

Co-Applicants Signature

Date

TO BE COMPLETED BY SALES CONSULTANT/ASSOCIATE

________________________________________

________________________________________

Dealer Number
Applicant Type of ID

Plan Number
[ ] Drivers License

[ ] State/Province Issued ID

[ ] Military ID

[ ] Passport

[ ] Tribal Card (please check one)

_______________________________________________

________________________________________ _________________________

Applicant Name on ID
Co-Applicant Type of ID

ID Number
[ ] Drivers License

[ ] State/Province Issued ID

_______________________________________________
Co-Applicant Name on ID
Sales Consultant

[ ] Military ID

ID Expiration Date
[ ] Passport

[ ] Tribal Card (please check one)

________________________________________ _________________________
ID Number

________________________________________

________________________________________

Name

Phone Number

________________________________________
Email Address

ID Expiration Date