Hebrew Free Loan Association of Greater Washington

Your Name

*

First Name

Last Name

Social Security Number

*

Please provide your full SSN

Date of Birth

*

(mm/dd/yyyy)

Are you a US Citizen or Permanent Resident?

*

I am a current Client of JCADA

*

I have completed JCADA's Allstate financial literacy curriculum

*

Marital Status

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Spouse Name

*

First Name

Last Name

Spouse Social Security Number - last 4 digits

*

Please provide the last 4 digits of your spouse's SSN

Do you identify as part of a relgion?

*

This is only for data tracking purposes and does not impact your loan application

What is your primiary religion

*

This is only for data tracking purposes and does not impact your loan application

Number of Dependent Children

*

Ages of Dependent Children

Loan Information

Purpose of the loan

*

Please explain why you need the loan and how the funds will be utilized.

Loan Amount Requested

*

Maximum amount of loan is $5,000

Contact Information

Email

*

Verify Email

*

Spouse's Email

*

Verify Email

*

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

How long have you lived at this address?

*

Do you own or rent this property?

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Own

Rent

Other

Cell Phone

*

Spouse's Cell Phone

*

Work Phone

Home Phone

Assets and Revenue

Occupation

*

Employer

*

Spouse occupation

Spouse Employer

Salary per Month

*

Spouse Salary per Month

Cash in bank

*

Additional Monthly Income

Investment income, pension, etc for both you and your spouse

Pay Stubs

*

Please upload your two most recent pay stubs. If you are self employed and do not have a pay stub, please provide Schedule C of your most recently filed tax return or another proof of income. For students: please upload documentation showing that you are currently enrolled in school.

Additional Pay Stubs

If your pay stubs are in two separate files, please upload the second one here. If you want to include additional documents, please email them to shuli@hebrewfreeloandc.org.

Liabilities and Expenses

Mortgage/Rent

*

Please provide monthly expenditure, if none, enter $0.

Car Loans

*

Please provide monthly expenditure, if none, enter $0.

Other debt payments (e.g., credit card, student loans, etc.)

*

Please provide monthly expenditure, if none, enter $0.

Tuition

*

Please provide monthly expenditure, if none, enter $0.

All other monthly expenses

*

Please provide approximate monthly expenditure for food, medical, car insurance, phone bills, gas and electric, clothing, etc

Debt: Please list the full amounts of debt owed to others, including mortgage, student loans, credit card, etc.

*

Please itemize the items listed above

Are there any court judgments against you or your spouse?

*

Yes

No

Are you currently being sued?

*

Yes

No

If yes, please explain...

Comments or Questions?

Notice to Borrower

Thank you for your interest in a loan from Hebrew Free Loan Association of Greater Washington (HFL). Please read the following statement and provide your electronic signature to signify that you agree. Please ask for an explanation if there is anything you don't understand.

I understand that I will be responsible to repay this loan as set forth in the Promissory Note. Loan repayments begin the month following the loan signing.
I undetand that in the event that I default on the Promissory Note and fail to pay as agreed, The Hebrew Free Loan Association of Greater Washington can use any and all legal collection methods against me including but not limited to bringing a lawsuit against me in order to seek repayment of all monies due and owing, to get a judgment against me for the balance due and owing and engage in any post judgment proceedings to enforce any judgment entered against me, including the garnishment of wager where applicable.
I understand that if a judgment is entered against me that becomes a public record.
I understand that this application is not the contract that makes me liable for the debt.

I have read the Notice to Borrower and understand the responsibilities

*

Yes

No

I hereby certify that the information provided is true, correct, and complete.

*

I authorize the Hebrew Free Loan Association of Greater Washington (HFL) to investigate my credit, credential and/or employment history and authorize HFL to make inquiries and gather information that it believes is necessary concerning statements made on this application. I further agree to promptly notify HFL of any material changes in the information in this application.