Your Name

Drivers License or State ID #

State Issued:

Email

Home Address

Primary Phone

Date of Birth

How did you hear about us?

How long in home?

Rent or Own

Monthly Payment

Income type

Name of Employer

Work Phone

Employer Address

How long have you been on this job?

When are you paid?

Other

Take home amount per month

What is a comfortable payment amount for you to make each payday?

Bank Name

Bank Routing #

Checking Account #

How long have you had this account?

Are you paid via Direct Deposit?

Secondary Income Type

Secondary Employment

Employer Address

How long have you been at your 2nd job?

When do you get paid this income:

Other payday:

Secondary monthly take home amount:

Reference 1 Name:

Reference 1 Address

Reference 1 Phone:

Reference 1 Relation:

Reference 2 Name:

Reference 2 Address

Reference 2 Phone:

Reference 2 Relation:

BY TYPING YOUR NAME IN THE BOXES BELOW, YOU CERTIFY THAT THE CONFIRMATION ABOVE IS COMPLETELY TRUTHFUL, AND UNDERSTAND THAT LYING TO OBTAIN CREDIT IS A CRIME PUNISHABLE BY LAW. YOU ALSO FULLY AUTHORIZE NICE GUYS LENDING SERVICES, INC. TO VERIFY THE TRUTHFULNESS OF THE ABOVE INFORMATION BY ANY MEANS NECESSARY INCLUDING FAX OR CALLING ANY PERSON OR FIRM LISTED ABOVE. YOU FULLY RELEASE ALL PARTIES FORM ANY AND ALL DAMAGES THAT MAY RESULT. ANY FALSE STATEMENTS MADE BY YOU SHALL BE SIGNIFICANT GROUND FOR REJECTION OF YOUR APPLICATION. YOU CERTIFY THAT YOU ARE NOT IN OR CONTEMPLATION NOR HAVE SPOKEN WITH ANY ATTORNEY REGARDING PERSONAL BANKRUPTCY, AND THAT YOUR DO NOT PLAN TO GO THROUGH OR FILE BANKRUPTCY IN THE NEXT TWO MONTHS. YOU CERTIFY THAT YOU HAVE READ AND UNDERSTOOD THE ABOVE STATEMENTS. YOU ACKNOWLEDGED THAT THAT APPLICATION AND ANY SUPPORTING DOCUMENTS PROVIDED WITH IT ARE PROPERTY OF NICE GUYS LENDING SERVICES, INC. YOU ALSO AUTHORIZE NICE GUYS LENDING SERVICES, INC. TO DO A CREDIT CHECK AT ANY TIME DURING YOUR APPLICATION FOR CREDIT AND UNTIL YOUR LOAN IS PAID IN FULL.

Length Desired (1-6 Months):

Amount Desired :

Digital Signature: Type Your Name:

Date: