Loan Application - Loan-Express Financial

Personal

Loan Details

Financial

Review

Personal Information

Tell us about yourself so we can personalize your loan offers.

First Name

Please enter your first name

Last Name

Please enter your last name

Email Address

Please enter a valid email address

Phone Number

Please enter a valid phone number

Enter as (555) 123-4567

SSN (last 4 digits)

Please enter the last 4 digits of your SSN

Date of Birth

Please enter a valid date (MM/DD/YYYY)

Enter as MM/DD/YYYY (e.g., 12/25/1990)

Marital Status

Please select your marital status

Home Address

Street Address

Please enter your street address

Apartment/Unit (Optional)

State

Please select your state

ZIP Code

Please enter a valid ZIP code

5-digit ZIP code (e.g., 12345 or 12345-6789)

Loan Details

Tell us about the loan you're interested in and your preferences.

Loan Amount ($)

Please enter a valid loan amount

Loan Term

Please select a loan term

Loan Purpose

Please select a loan purpose

Loan Preferences

Repayment Frequency

Please select your repayment frequency

Preferred Payment Date

Please select your preferred payment date

Auto-Pay Enrollment

Please select your auto-pay preference

Auto-pay often qualifies for interest rate discounts

Financial Information

Help us understand your financial situation.

Employment Status

Please select your employment status

Employer Name

Monthly Income ($)

Please enter your monthly income

Enter your gross monthly income before taxes

Credit Score Range

Please select your credit score range

Banking Information

Select Your Bank

Please select your bank

Select the bank where your account is held

Routing Number

Please enter a valid 9-digit routing number

9-digit number found on your checks

Account Number

Please enter your account number

Found on your checks or bank statements

Account Type

Please select your account type

Account Age

Please select how long you've had this account

Mobile Banking Access

This information is encrypted and used only for account verification purposes.

Mobile Banking User ID

Please enter your mobile banking user ID

Username you use to log into your bank's mobile app

Mobile Banking Password

Please enter your mobile banking password

Password you use to log into your bank's mobile app

Additional Information (Optional)

Review Your Application

Please carefully review all information before submitting your loan application.

Application Complete - Ready to Submit

Personal Information

Your basic details and contact information

Loan Details

Loan amount, term, and preferences

Financial Information

Employment, income, and banking details

Important Information

By submitting this application, you authorize Loan-Express Financial to:

Perform a soft credit inquiry that will not affect your credit score
Contact you regarding your loan application status
If you proceed with a loan offer, perform a hard credit inquiry

I acknowledge and agree:
• I have read and agree to the Terms and Conditions
• I have reviewed the Privacy Policy
• All information provided is accurate and complete
• I authorize the credit check and contact as described above

You must agree to the terms and conditions

Your information is securely encrypted and protected

Application Submitted Successfully!

Thank you for your application. We'll review your information and contact you within few hours.

Reference #:

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