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Loan Information
Total Amount of Loan: $ (No Decimals)
Reason for Loan:

Purchase Information
Year: Make: Model: Down Payment:
Referral Information
Referred By:

Service Information
Organization Name: Swiss Bionic Solutions USA

Applicant Information
Borrower Co-Borrower
First Name: MI: Last Name:

Mother's Maiden Name: Credit Rating:

Don't know? Get it here.
First Name: MI: Last Name:

Relationship to Applicant: Credit Rating:

Don't know? Get it here.
SSN:
 -   - 
Date of Birth:
 /   / 

Email: No Email
SSN:
 -   - 
Date of Birth:
 /   / 

Email: No Email
Current Address: (Cannot contain PO Box)


City: State: Zip:
Current Address:


City: State: Zip:
Time at Current Address: Years Months

Housing: Monthly Rent/Mortgage:
$
Time at Current Address: Years Months

Housing: Monthly Rent/Mortgage:
Home Phone: Alternate/Cell Phone:

Drivers License State: Drivers License #:
Home Phone:
Complete below if applicant has moved in the last 2 years
Complete below if Co-applicant has moved in the last 2 years
Previous Home Address:

City: State: Zip
Previous Home Address:

City: State: Zip
Time at Previous Address:
Years Months
Time at Previous Address:
Years Months
Employer Information
Employer Name: Position:
Position if NOT listed above:

Income: Numbers only (e.g. 35000)
Employer Name: Position:
Position if NOT listed above:

Income:
Employer Address:

City: State: Zip:
Employer Address:

City: State: Zip:
Business Phone: Time at Current Employer:
Years Months
Business Phone: Time at Current Employer:
Years Months
Other Income: Source of Other Income:

Bankruptcy: If yes, when:
 / 
Other Income: Source of Other Income:

Bankruptcy: If yes, when:
 / 
Complete below if applicant has changed jobs in the last 2 years
Complete below if Co-applicant has changed jobs in the last 2 years
Previous Employer: Position:
Position if NOT listed above:

Time at Previous Employer: Years Months
Previous Employer: Position:
Position if NOT listed above:

Time at Previous Employer: Years Months
Previous Employer Address:

City: State: Zip
Previous Employer Address:

City: State: Zip
Secured Loan (Optional)
If required, would you use your home as collateral?
If yes, please fill out the additional items below and if 2 people are listed on the house, please fill out cosigner information.
Estimated Property Value: Current Mortgage Balance:

AUTHORIZATION TO RELEASE CREDIT INFORMATION AND CREDIT POLICIES
By submitting my information, I authorize EFS (eFinancing Solutions) (and/or their authorized lenders or lending partners) to run a credit report and verify the information I have provided. I understand ESF will be acting as a loan-processing agent on my behalf and therefore does not deny, approve, set the interest rate and terms, guarantee loan approvals or discriminate against anyone for any reason. As a part of my search, I fully understand my credit report and score may be presented to multiple credit issuing companies and / or search companies including (but not limited to) Banks, Finance Partners, Credit Card Issuers and other such companies. I understand that some of the lenders or lending partners may charge a loan processing fee and/or an origination fee which will be disclosed to me prior to authorizing any documents. I agree to "hold harmless" EFS from any and all legal actions that might be taken as a result of a disputed matter with my Service Provider or Vendor.

By Checking the box below, and clicking the "Submit" button, I am confirming that I have read and agree to the following E-Consent Agreement and to:



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