APPLY NAMPA Date* MM slash DD slash YYYY Amount Requested*Purpose of Loan* Referred By?* PERSONAL INFORMATIONFirst Name* Last Name* Social Security #* Date of Birth* Phone*Email* Has Co-Applicant?* Yes No First Name Last Name Social Security # Date of Birth PhoneEmail Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Length at Address?* Marital Status/# of Dependents* Less than 3 years at current address?* Yes No Previous Address (if less than 3 years at current) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Address (if less than 3 years at current) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EMPLOYMENT INFORMATION (Please include 3 years of history)*Notice: Income from alimony, child support or separate maintenance payments need not be revealed if you chose not to have it considered.Current Employer* Address* Phone*Start Date* Position* Hours/Week* Hourly Rate* Gross Monthly Income* Net Monthly Income* Pay Schedule* Other Income* Source/Type* Previous Employer* Length of Employment* Previous Employer Length of Employment COLLATERALVIN* Year* Make* Model* Trim (Lx, Ls)* Mileage* Color* Do you owe against this collateral?* Yes No Idaho Title* Yes No Is the tile branded?* Yes No Mark All Applicable:* Auto Truck Motorcycle RV Boat Trailer ATV Equipment 2DR 4DR 4x4 Diesel Ext. Cab Crew Cab Type of Equipment* Do you have additional collateral?* Yes No VIN Year Make Model Trim (Lx, Ls) Mileage Color Do you owe against this collateral? Yes No Idaho Title Yes No Is the tile branded? Yes No Mark All Applicable: Auto Truck Motorcycle RV Boat Trailer ATV Equipment 2DR 4DR 4x4 Diesel Ext. Cab Crew Cab Type of Equipment REFERENCESName* Phone*Relation* Name* Phone*Relation* Name* Phone*Relation* Name PhoneRelation FINANCIAL INFORMATIONDo you have a checking account?* Yes No What financial institution? Had a bankruptcy?* Yes No Was it a* Chapter 7 Chapter 13 Discharged* Yes No Have you ever had a repossession?* Yes No What year?* What company* Housing Payment/Rent*CreditorBalanceMinimum PaymentCommentsAuto Loan*CreditorBalanceMinimum PaymentCommentsAuto Insurance*CreditorBalanceMinimum PaymentCommentsChild SupportCreditorBalanceMinimum PaymentCommentsDaycareCreditorBalanceMinimum PaymentCommentsMedicalCreditorBalanceMinimum PaymentCommentsCredit CardsCreditorBalanceMinimum PaymentCommentsGas Bill (Heat)CreditorBalanceMinimum PaymentCommentsSewer/Water/TrashCreditorBalanceMinimum PaymentCommentsPower BillCreditorBalanceMinimum PaymentCommentsCell PhoneCreditorBalanceMinimum PaymentCommentsCable/Dish/InternetCreditorBalanceMinimum PaymentCommentsStudent LoansCreditorBalanceMinimum PaymentCommentsRent to OwnsCreditorBalanceMinimum PaymentCommentsCheck Cashing LoansCreditorBalanceMinimum PaymentCommentsPayday LoansCreditorBalanceMinimum PaymentCommentsTitle LoansCreditorBalanceMinimum PaymentCommentsFederal Tax LiensCreditorBalanceMinimum PaymentCommentsState Tax LiensCreditorBalanceMinimum PaymentCommentsGarnishments Groceries (Food, Household Items)CreditorBalanceMinimum PaymentCommentsOther (Explain)CreditorBalanceMinimum PaymentCommentsCanyon Financial Proposed Loan PMTCreditorBalanceMinimum PaymentCommentsConsent* I hereby authorize the lender/ Broker to verify my past and present employment earnings records, bank accounts, stock holdings, and any other asset balances that are needed to process my loan application. I further authorize the Lender/ Broker to order a consumer credit report and verify other information, including past and present mortgage and landlord references. It is understood that a copy of this form will also serve as authorization. The information the Lender/ Broker obtains is only to be used in the processing of my application for a loan.
