American Financial

Type of Loan

Credit Card

Vehicle Loan

New     Used 

Signature Loan    

Purpose                

    Home Loan

Estimated Property Value 

Present Mortgage Balance

   Other     Purpose       

Application Type

  Individual

  Joint

  Spouse

   Non-Spouse

Loan Amount

     Amount Requested

Please Tell Us About Yourself

Full Name (First, Middle, Last)

ll

 Unmarried     Married       Separated

Home Address:

Street  

City       State Initials   Zip

Years at Address      

Own            Rent        Other       Monthly Rent/Mortgage

Social Security Number:   
Date of Birth:           

Home Phone with area code:    

Work Phone with area code:           

Driver’s License #  DL State

Mother’s Maiden Name:

Driver’s License Expiration Date:         

State of Birth:

Previous Address (If Less Than 5 Years At Current Address)

Street:

City:   

State:     Zip:   There:          

Please Tell Us About Your Job

Employer:                                          Position:   

Employer City:   Employer State:         Years There:

Gross Monthly Income      

Other Monthly Income       

Source of Other Income   

Previous Employer:    If Less Than 5 Years at Current Employer
Position:    Years There:       

Additional Information