Loan Application "*" indicates required fields Eligibility (Select all that apply)* I am Jewish I am a resident of the Greater Baltimore Area I am employed by the Associated How did you find out about HFLA?* Applicant InformationName* First Name (Legal) Last Name (Legal) Other Name Used Date of Birth MM slash DD slash YYYY Hidden HiddenSSN HiddenDriver Lic # Home PhoneMobile Phone*Email Address* Alternate Email Address Are Your Married?* Yes No Hidden Spouse's Name First Name (Legal) Last Name (Legal) Other Name Used Date of Birth MM slash DD slash YYYY Mobile PhoneHiddenSSN HiddenDriver Lic # Hidden Email Address Alternate Email Address Has your address changed in the last 2 years?* Yes No Hidden Your Current Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Prior Address (within the last 2 years) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dependents living in your household (Check all that apply):* Children Other Dependents None of the Above Ages of children at home Explanation of other dependents in the house Employment InformationOccupation Employer Years at this position Office Phone NumberSpouse's Occupation Spouse's Employer Years at this position Office Phone NumberOffice Address Street City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Spouse's Office Address Street City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Loan InformationLoan Amount Requested $Type of LoanChoose OneEducationAutomobile Purchase / ExpenseSmall BusinessReligious activityMedical needHome Improvement / RepairTemporary crisisDebt ConsolidationOther (Explain Below)Details of this loan requestAssets and IncomeDo you own a home?* Yes No Year Home Purchased Amount PaidMortgage BalanceEstimated Market ValueDo you own or lease a car(s)* Yes No Applicant has stated they do not own or lease a carHidden Car Year, Make, Model CostBalanceMonthly PaymentCar 2 Year, Make, Model CostBalanceMonthly PaymentCar 3 Year, Make, Model CostBalanceMonthly PaymentHidden Total Monthly Car PaymentsMonthly IncomeMonthly Salary - take home $Other Monthly IncomeHidden Spouse Salary - take home $Spouse Other IncomeHidden Total Monthly IncomeBank Accounts and Other AssetsCheckingSavingsRetirement AccountsOther AssetsMonthly DebitsDo you have any credit cards* Yes No Applicant has stated they do not have any credit cardsHidden Credit Card Company BalanceMonthly PaymentHidden Credit Card Company BalanceMonthly PaymentHidden Credit Card Company BalanceMonthly PaymentHidden Credit Card Company BalanceMonthly PaymentHidden Total Balance of all CCsTotal Monthly CC PaymentsOther Expenses (NOT included on credit card(s))Rent/MortgageBGE/Utilities/WaterTotal TuitionAuto InsuranceLandlineCellular PlanFood/clothingHealth InsuranceInternet/SubscriptionsLoans (student, etc)Other Expenses 1Other Expenses 2Hidden Total Addl Monthly ExpensesTotal Cash FlowHidden Total Monthly IncomeAll IncomeTotal Monthly ExpensesAll ExpensesMonthly Net Cash FlowAll Income minus All expensesI understand that by submitting this application I authorize the Hebrew Free Loan Association of Baltimore (HFLA) to consult with the Jewish Community Services (JCS), CHANA or other affiliated or collaborating agencies with The Associated, or the like, if deemed necessary in order to gather information that it believes is necessary concerning statements made on this application.
