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*All fields are required for completion of application.
APPLICANT: Please read the following before completing this form. You are applying for joint credit. Married applicants may apply for an individual account.
Joint Credit Application
APPLICANT MUST: -LIVE WITHIN A 45 MILE RADIUS FROM LOUISVILLE, KY. - Min 1 Year of Full Time Employment at Same Employer. - Min 1 Year at Residence. -Have $1,200 minimum income -Must have Established Credit in good standing Please check here to confirm you meet these requirements.
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I Agree
Loan Information
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Indicates required field
How did you find us?
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Select One
Current Customer
Former Customer
Google Search
Other
Received Flyer
Referral
Facebook
Newspaper
Received Post Card
Purpose of Loan
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Select One
Auto Purchase
Auto Repair
Back to School
Bill Consolidation
Establish Credit
Medical Bills
Pay Bills
Vacation
Other
Holiday
Amount Requested
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Referred By:
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Personal Information
Name
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First
Last
Social Security Number
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Date of Birth
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Housing Status
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Select One
Rent
Own (No Mortgage Payment)
Live with Someone
Mortgage Payment
Mortgage Payment / Rent
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How many years/months at residence?
# of Years
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# of Months
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Home Phone Number
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Cell Phone Number
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By providing my mobile and/or home number, including a number that I later convert to a mobile number, I consent to receive calls, text messages by or on behalf of Jefferson Financial Services, Inc. regarding the processing of my loan application and, if approved, for other transactional purposes, such as the collection and servicing of my account. I understand my consent for non-marketing calls and messages applies to each phone number that I voluntarily provide to Jefferson Financial Services, Inc. now or in the future or obtained by Jefferson Financial Services, Inc. through other lawful means.
Email
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Employment Information
Employers Name
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Employers Address
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Employers Phone Number
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Employment Type
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Select One
Full Time
Part Time
Your Position
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Gross Monthly Income
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How many years/months at employer?
# of Years
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# of Months
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Additional Income: Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
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Do you pay child support or alimony?
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Select One
Yes
No
Have you filed Bankruptcy in the past?
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Select One
Yes
No
Are you a Co-Signer on any other loans?
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Select One
Yes
No
Co-Applicant Information
Co-Applicant Name
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First
Last
Co-Applicant Social Security Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Co-Applicant Date of Birth
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Co-Applicant Home Phone Number
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Co-Applicant Cell Phone Number
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Co-Applicant Employment Information
Co-Applicant Employers Name
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Co-Applicant Employers Address
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Line 1
Line 2
City
State
Zip Code
Country
Co-Applicant Employers Phone
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Co-Applicant Employment Type
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Select One
Full Time
Part Time
Co-Applicant Position
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Co-Applicant Gross Monthly Income
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How many years/months at employer?
# of Years
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# of Months
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Comment
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By submitting this Loan Inquiry Form, I/We acknowledge and certify for the purpose of obtaining credit from you and with the intent that you will rely heron and to induce you to extend said credit, that the information given herein is complete, true and correct and at this time I/We fully realize that you are relying upon this to extend credit to me/us. The applicant expressly authorizes Jefferson Financial Services, Inc. to make inquiries of others concerning the foregoing information and to provide information arising out of the applicant's transactions with you to others. Any person or entity named herein is expressly authorized to furnish you with information in connection with this application. Your Social Security Number is required so we can access your credit report and shorten the approval process.
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I/We Agree
All loans are subject to our normal credit requirements and may be subject to the provision of acceptable collateral for the loan. All loans must be closed in the office located at 5618 Bardstown Road Louisville, KY. If you have an existing account with Jefferson Financial Services Inc., it will be refinanced and any unearned interest will be rebated in accordance with your original loan agreement.
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