Consumer Home Loan Request
Financing Available for Manufactured, Mobile, and Modular Homes as well as Traditional Built Homes

Applications are not solicited from those under 18 years of age.

Welcome to Alliance Credit, LLC's on-line loan request. Please complete this form and e-mail it to us by clicking SUBMIT at the bottom of the page.We will contact you to acknowledge that we've received the form and we'll let you know what else we need to continue processing your application. Please feel free to submit this form right here online or either fill in the form and print it out to either mail or fax to our office.

Required fields are indicated with a *

Important: Please read these instructions before completing this application.

* Check Appropriate Box:

If you are applying for individual credit in your own name and are relying on your own income or assets and not the income of another person as the basis for repayment of the credit requested, complete SECTION A and D, OMITTING B and C. If the requested credit is to be secured, also complete the first part of SECTION C as it relates to applicant.
If this is an application for joint credit with another person, complete SECTIONS A through D, providing information in SECTION B about joint applicant.
If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete SECTIONS A through D to the extent possible, providing information about the person on whose alimony, support or maintenance payments or income or assets you are relying.

How Much Would You Like To Borrow?

Loan Amount:
What is the purpose of the loan?
Number of Months?

Type of Loan Requested (check all that apply):

Purchase  Home Improvement 
Refinance  Consolidation/Cash Advance 

 

 

If this is a purchase, what is the purchase price?
If this is a refinance, what is the estimated payoff of your loan?

If this is a home improvement, what are the estimated costs for the improvement?

 

SECTION A

Please Tell Us About Yourself.

* First Name: * Middle Initial:
* Last Name:
* Social Security #:
* Street Address:
* Apartment #:
* City:
* State: * Zip Code:
* Email:
*Mother's Maiden Name
* Home Phone: Best time to call:
Daytime Phone:
Housing: Own Rent Parents/Relative Other

Landlord or Mortgage:

Monthly Pymt.
Are you an American Citizen? Yes No

Please Tell Us About Your Income.

Alimony, child support, or separate maintenance income need not be revealed if you do not wish it considered as a basis for repaying this obligation.

Job Title: Gross Monthly Salary:
Self Employed Retired Unemployed
Name of Employer or Business:
Street Address:
City: State:
Zip Code: Phone Number:
Time with current employer: Years: Months:
Other income: Monthly Annually

Checking Account, Bank Name:

Account Number:

Savings Account, Bank Name:

Account Number:

Do You Have Any Other Additional Checking or Savings Accounts?
Yes No

 Please List Bank Name, Account Number and Balance:

Please Tell Us Your Credit References.

Mortgage Creditor:
  Pay with Proceeds: Yes No
Balance:
  Payment Amount:
Home Equity/2nd Mtg. Creditor:
  Pay with Proceeds: Yes No

Balance:

  Payment Amount:
Auto Creditor:
  Pay with Proceeds: Yes No

Balance:

  Payment Amount:
Other Creditor:
  Pay with Proceeds: Yes No

Balance:

  Payment Amount
Other Creditor:
  Payment: Yes No

Balance:

 

Payment Amount:
Were you ever bankrupt or had judgments, liens or legal proceedings against you in the past seven years?
Yes No
Are you a joint applicant, endorser, or guarantor on any other loans?
Yes No

Personal References:

Name of the nearest
relative not living with you:
Address:
City:
State Zip Code:
Relationship:
Phone:

SECTION B

Joint Applicant or Other Party:

Please do not complete "Joint Applicant or Other Party" information if you are applying for individual credit in your own name unless you are relying on the income from alimony, child support or separate maintenance, or the income or assets of another party as the basis for repayment of the credit requested.

Please Tell Us About That Person.

* First Name: * Middle Initial:
* Last Name:
* Social Security #:
* Street Address:
* Apartment #:
* City:
* State: * Zip Code:
* Email:
*Mother's Maiden Name
* Home Phone: Best time to call:
Daytime Phone:
Housing: Own Rent Parents/Relative Other

Landlord or Mortgage:

Monthly Pymt.
Are you an American Citizen? Yes No

Please Tell Us About That Person's Income.

Alimony, child support, or separate maintenance income need not be revealed if you do not wish it considered as a basis for repaying this obligation.

Job Title: Gross Monthly Salary:
Self Employed Retired Unemployed
Name of Employer or Business:
Street Address:
City: State:
Zip Code: Phone Number:
Time with current employer: Years: Months:
Other income: Monthly Annually

Checking Account, Bank Name:

Account Number:

Savings Account, Bank Name:

Account Number:

Do You Have Any Other Additional Checking or Savings Accounts?
Yes No

 Please List Bank Name, Account Number and Balance:

Please Tell Us About That Person's Credit References.

Mortgage Creditor:
  Pay with Proceeds: Yes No
Balance:
  Payment Amount:
Home Equity/2nd Mtg. Creditor:
  Pay with Proceeds: Yes No

Balance:

  Payment Amount:
Auto Creditor:
  Pay with Proceeds: Yes No

Balance:

  Payment Amount:
Other Creditor:
  Pay with Proceeds: Yes No

Balance:

  Payment Amount
Other Creditor:
  Payment: Yes No

Balance:

 

Payment Amount:
Were you ever bankrupt or had judgments, liens or legal proceedings against you in the past seven years?
Yes No
Are you a joint applicant, endorser, or guarantor on any other loans?
Yes No

Personal References:

Name of the nearest
relative not living with you:
Address:
City:
State Zip Code:
Relationship:
Phone:

Complete Information for Proposed Collateral:

Titled Unit:

Purchase Own Year

Make

Model State of Location
Dealer Sales Agent

Serial Number

Purchasing From:

Dealer Name

Dealer Address:

Dealer Address:

Name(s) on Title:

Is there anything else you would like us to know?

SECTION C

Marital Status

Are you the applicant: Married Separated Unmarried (includes single, divorced, widowed)

Are you the co-applicant: Married Separated Unmarried (includes single, divorced, widowed)

SECTION D

Certification

By submitting this information, I (we) certify that all the information in the above application is true and complete and given for the purposes of securing credit. I (we) understand that you may request a consumer report in connection with this application, and, if I (we) ask, I (we) will be informed whether or not such a report was requested and, if so, the name and address of the consumer reporting agency that furnished the report. I (we) also authorize you to check my (our) employment history and to exchange account and credit information about me (us) to the extent permitted by law. Further, I (we) acknowldge having reviewed the Alliance Credit Privacy Notice.

We appreciate your business.