L&L Motors Loan Application Please print this form, fill it out and bring it in with you. Close this Page

Primary Applicant:
First Name:	Middle Name:
Last Name:	Marital Status:
Social Security Number (TIN):	Date of Birth:
Number of Dependents:	Ages of Dependents:
Home Phone Number:	Work Phone Number:
Other Phone Number:	Email Address:
Drivers License #:	Drivers License State:
Home Address
Address 1:
Address 2:
City:	State, Zip:
Time at Current Residence:	Residence Type: Rent Own Other:
Monthly Payment:	Landlord or Mortgage Holder:
Previous Address (if less than 2 years at present)
Address 1:
Address 2:
City:	State, Zip:
Time at Previous Residence:	Residence Type: Rent Own Other:
Present Employer
Name:	Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title:	Job Start Date:
Wages:                                  net/gross (circle one)	per Year Bi-Weekly   Weekly
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.
Other Income:	per Year Bi-Weekly   Weekly
Other Income Source:
Previous Employer (if less than 2 years at present)
Name:	Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title:	Job Start Date:
Job End Date:
Wages:                                  net/gross (circle one)	per Year Bi-Weekly   Weekly

Co-Applicant:
First Name:	Middle Name:
Last Name:	Marital Status:
Social Security Number (TIN):	Date of Birth:
Number of Dependents:	Ages of Dependents:
Home Phone Number:	Work Phone Number:
Other Phone Number:	Email Address:
Drivers License #:	Drivers License State:
Home Address
Address 1:
Address 2:
City:	State, Zip:
Time at Current Residence:	Residence Type: Rent Own Other:
Monthly Payment:	Landlord or Mortgage Holder:
Previous Address (if less than 2 years at present)
Address 1:
Address 2:
City:	State, Zip:
Time at Previous Residence:	Residence Type: Rent Own Other:
Present Employer
Name:	Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title:	Job Start Date:
Wages:                                  net/gross (circle one)	per Year   Bi-Weekly   Weekly
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.
Other Income:	per Year Bi-Weekly   Weekly
Other Income Source:
Previous Employer (if less than 2 years at present)
Name:	Phone Number:
Employment Status: Full Time Part Time Temp Retired Other (please specify):
Job Title:	Job Start Date:
Job End Date:
Wages:                                  net/gross (circle one)	per Year Bi-Weekly   Weekly

References
Nearest Relative Not Living With You
Last Name:	First Name:
Relationship:	Phone Number:
Address 1:
Address 2:
City:	State, Zip:

Debts/Monthly Payments:
List all other debts (for example, credit cards, alimony, child support, medical, IRS liabilities, etc.) Please use a separate line for each credit card.
Debt	Monthly Payment	Debt	Monthly Payment

Assets:
List all other assets (for example, real estate, automobiles, trailers, etc.)
Type of Asset	Market Value	Outstanding Loan
Savings & Checking		---------
Real Estate (location)
Automobile (year, make, model)
Other (describe)
Other (describe)

Additional Information

How would you prefer to be contacted?   Home Phone   Work Phone   Other Phone   Email Address   Other:

Special Instructions/Comments:

Signatures
Income verification is required; other information may be required. I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)
Primary Signature:	Date:
Joint Owner Signature:	Date: