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Loan Application
New Auto VISA Premium Auto Equity Loan RV / Motorcycle Loan	Used Auto VISA Classic Home Equity Loan Computer Loan	Auto Refinance Home Equity Line of Credit Personal Line of Credit Personal Loan Other:
Type of Loan Applying For:	Loan Amount$:
Applicant Information
Full Name:
Social Security # :
Birth Date (ex.(01/02/70):
Are You : Married Unmarried Separated
Home Phone:
Work Phone:
Street Address:
City / State / Zip:
Employer:
Monthly Salary:
Hire Date:
Do You: Own Rent Living with Parents
Monthly Rent or Mortgage $	Mortgage Bal.$
Approx. Home Value $	Savings Total $
Other Debts $	Total Monthly Payments $
Co-Applicant Information
Full Name:
Social Security # :
Birth Date (ex.(01/02/70):
Are You: Married Unmarried Separated
Home Phone:
Work Phone:
Street Address:
City / State / Zip:
Employer:
Monthly Salary:
Hire Date:
Do You: Own Rent Living with Parents
Monthly Rent or Mortgage $	Mortgage Bal.$
Approx. Home Value $	Savings Total $
Other Debts $	Total Monthly Payments $
Please provide a copy of your most recent pay stub. Fax to: (408) 225-6712