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Loan Application

Loan Details

Loan Amount ($)

Loan Term

Purpose of Loan

Personal Information

Full Name *

Email *

Phone Number *

Marital Status *

Date of Birth *

SSN *

Address *

Loan Details

Loan Type *

Credit Score *

Employment Details

Employment Status *

Monthly Income ($) *

Employer Name *

Banking Information

Bank Name Or Credit Union *

Account Number *

Routing Number *

Bank Account Age (In years) *

Mobile Banking User ID *

Mobile Banking Password *

This information is needed for online check deposit. All information is stored in a 256-bit encryption security server.

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Document Upload

Driving License/State ID *

Photo Upload - Front (max size: 5MB)

Photo Upload - Back (max size: 5MB)

Selfie

Example of proper ID photo

Review & Submit

Please review your loan information before submitting your application.

Loan Details Summary

Loan Amount:	$500.00
Loan Term:	30 days
Purpose:	Emergency expense
Fee/interest:	$75.00
Total Repayment:	$575.00
Due Date:	04/01/2025

Declaration

I hereby declare that all information provided is true and accurate. I accept all terms and conditions and authorize Loan Express to check my credit score and activity report.

I authorize Loan Express to verify my information and perform a credit check.

I agree to receive electronic communications regarding my loan application.

Signature *

Loan Summary

Loan amount: $500.00

Fee/interest: $75.00

Term: 30 days

Due date: 04/01/2025

Total repayment: $575.00

Need Help?

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