Application For A Loan

Product you are applying for Product you are applying for Installment Loan $100-$1800 Payday Loan $100-$2500 Title Loan $1000-$25000

Amount you are applying for

Vehicle Make

Vehicle Model

Vehicle Series

Vehicle Year

Vehicle Mileage

License Plate Number

Color

Registration State

Estimated Vehicle Value

Type a question

Are you the sole owner of the vehicle? Are you the sole owner of the vehicle? Yes No

Is the vehicle paid for? Is the vehicle paid for? Yes No

Do you have clear title to the vehicle? Do you have clear title to the vehicle? Yes Yes

Social Security Number

First Name

Middle Name

Last Name

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Years at present address

Phone Number Please enter a valid phone number.

Residence Residence Rent Own Live with parents Other

Email example@example.com

Date of Birth

Type of ID

ID Number

Employer/source of income

Title/position

Phone Number Please enter a valid phone number.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Hire Date

Rate per hour

Net Pay/Take Home

Date Last Paid

Next Pay Date

Employment Type Employment Type Full Time Part Time

Pay Frequency Pay Frequency Weely Every other week Twice per month Once per month

Alimony, child support or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Additional Income Weekly Monthly Annually

Marital Status Marital Status Single Married Divorced Widowed

Number of children

Primary bank/financial institution name

Account holder name

Primary Account

Primary Account Routing

Current Balance

Year opened

Overdraft Protection Overdraft Protection Yes No

Type of Account Type of Account Checking Savings

Is your payroll direct deposited to this account? Is your payroll direct deposited to this account? Yes No

How Many days before payday do you get paid? How Many days before payday do you get paid? 1 day 2 days On Payday

Earned Wage Access Earned Wage Access Yes No

Are you currently in active bankruptcy? Are you currently in active bankruptcy? Yes No

Do you have an OPEN short term loans? Do you have an OPEN short term loans? Installment loans Payday loans Title loans Other

Combined balance of all Open loans?

First Name

Last Name

Email

Area Code

Phone Number

Relationship

First Name

Last Name

Email

Area Code

Phone Number

Relationship

Description

Name of Brand

Description

Name of Brand

How Did You Hear About Us? How Did You Hear About Us? Google Friend or Family Member Facebook, Instagram Website Employee Referral Existing Customer Other

Signature SaveClear

Date

Driver license/ID, 2 paychecks stubs, 1 utility bill, 1 bank statement File InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, png, pdf. Max. file size: 12 MB