How did you find out about HFLA?

Eligibility (Select all that apply) Eligibility (Select all that apply) I am Jewish I am a resident of the Greater Baltimore Area I am employed by the Associated

Applicant Information Applicant Information

First Name *

Other Name Used

Last Name *

Date of Birth DD/MM/YY

Home Phone (xxx)-xxx-xxxx

Mobile Phone * (xxx)-xxx-xxxx

Email Address

Are you married? Are you married? Yes No

Spouse's First Name

Spouse's Other Name Used

Spouse's Last Name

Spouse's Date of Birth DD/MM/YY

Spouse's Mobile Phone (xxx)-xxx-xxxx

Spouse's Email Address

Address (including zipcode)

How many years have you lived at your current address?

Prior Address (including zipcode)

Are there children living in the household? Are there children living in the household? Yes No

How many?

List the age(s) of child(ren)

Are there other dependents living in the household? Are there other dependents living in the household? Yes No

Explain.

Loan Information Loan Information

Please provide specific details of this loan request.

Loan Amount Requested $

Type of Loan Type of Loan Education Automobile Purchase / Expense Small Business Religious activity Medical need Home Improvement / Repair Temporary crisis Debt Consolidation Other

Please write the type of loan.

Employment Information Employment Information

Occupation

Employer

How many years have you been employed with your current employer?

Address of Employment

Office Phone Number (xxx)-xxx-xxxx

Spouse's Occupation

Spouse's Employer

Spouse's Address of Employment

Spouse's Office Phone Number (xxx)-xxx-xxxx

How many years has your spouse been employed with his/her current employer?

Assets Assets

Do you own your home? Do you own your home? Yes No

Year purchased

Amount Paid $xxxxx.xx

Mortgage Balance $xxxxx.xx

Mortgage Lender

Estimated Market Value $xxxxx.xx

Do you own a car(s)? Do you own a car(s)? Yes No

Year

Make

Model

Cost $xxxxx.xx

Balance $xxxxx.xx

Monthly Payment $xxxxx.xx

Do you own another car? Do you own another car? Yes No

Year

Make

Model

Cost $xxxxx.xx

Monthly Payment $xxxxx.xx

Balance $xxxxx.xx

Do you own another car? Do you own another car? Yes No

Year

Make

Model

Cost $xxxxx.xx

Monthly Payment $xxxxx.xx

Balance $xxxxx.xx

Name of Primary Bank

Total Checking: (approx) $xxxxx.xx

Total Savings: (approx) $xxxxx.xx

Total Retirement Accounts: (approx)

Total Investments: (approx) $xxxxx.xx

Other Assets $xxxxx.xx

Debits Debits

How many credit cards to you own?

Total Monthly Credit Card Payments $xxxxx.xx

Income $xxxxx.xx Income $xxxxx.xx

Approximately how much does the applicant's salary net per month? $xxxxx.xx

Approximately how much does your spouse's salary net per month? $xxxxx.xx

Approximately how much does any other income net per month? $xxxxx.xx