LOAN APPLICATION FORM

I am requesting a loan in the amount of _____ DOLLARS on my ____________ Collection. This collateral is my property and free and clear of all encumbrances.

 

I am sending the collateral by (please check one):

Registered Mail

Federal Express or UPS

Express Mail

Other

 

This application, including the provisions printed on the original Loan Agreement and the attached Terms and Conditions contain and constitute the entire agreement of the parties. The final acceptance of the loan proceeds by Borrower shall deemed an acknowledgement and an approval of this loan agreement by Borrower.

Loan Applicant (Borrower)
Last Name:____________________		First Name:____________________
Signature:_________________________________
Address:_____________________________________________________________
City:____________________	State:___	Zip:__________
Daytime Phone:________________________		Nighttime Phone:___________________
Social Security #:_____________________