Easy Financing Worksheet

By completing this form you authorize Northern Diverse LLC to check your credit rating and submit information to lending agencies. Northern Diverse LLC will not sell your information to other companies.

Personal Loan     With a Co-Applicant

Amount to finance

Items/vehicles you are interested in?

Male Female

Home phone  Cell phone  Work phone  

Your E-mail address

Date of Birth Social Security Number

Driver's license number Expiration date   State

Married     Separated     Unmarried (single, divorced, Widowed, etc.)

U.S. Citizen: Yes     No

If no, country of citizenship  Are you a resident alien? Yes     No

Own Home   Rent Home   Other    Payment per month

House Number   Name of Street

Street Type: Blvd., Avenue, etc.  Apt/Unit #

City State/Zip County/Borough

How long at present address: Years Months

NOTE: If at residence fewer than 2 years give previous address:

House Number  Name of Street

Street Type: Blvd., Avenue, etc.  Apt/Unit #

City State/Zip County/Borough

Employed   Self-Employed   Retired/Student   Not Employed   Homemaker

Employer name     Position   

Years employed    Months employed   Years in profession

If self-employed indicate business type: 

Sole Proprietorship   Partnership   Corporation

Work phone  

NOTE: If employed less than 2 years, who was previous employer?  

Position  

Time with previous employer:     Years       Months 

GROSS MONTHLY INCOME BEFORE TAXES  (if self-employed, what is your income less expenses?)  

Other income per month (income NOT included in your gross monthly listed above such as alimony, child support, Soc. Sec. income, retirement, part time work, rentals, etc.)

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