Identity Verification: To help the government fight the funding of terrorism and
money laundering activities, Federal law requires all financial institutions to
obtain, verify, and record information that identifies each person who opens an
account. As a result, under our customer identification program, we must ask for
your name, street address, mailing address, date of birth, and other information
that will allow us to identify you. We may also ask to see your driver’s license
or other identifying documents.
Enter the legal name of the primary borrower:
Provide the personal idenity information that matches the primary borrower's name above.
Enter the address of the primary borrower: (MUST BE A VALID STREET ADDRESS
NO P.O. BOXES)
Indicate the state the primary borrower has legal residence.
|Legal State of Residence:
||Time at Residence:
Note: Other source of Income and amount. Please note, such income need not be revealed
if the applicant does not want the creditor to consider it in determining the applicant's
Enter all amounts as Monthly values.
Include current living expense.
Enter (1) one personal reference below:
Enter current employment details.
Please read before Continuing.
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.
I HEREBY ACKNOWLEDGE that I am over the age of eighteen (18) years, and that all of the information set forth in this credit statement is true, accurate and full and complete disclosure thereof. I am providing written consent under the Fair Credit Reporting Act for above client and its partners with whom I am matched to obtain a consumer credit report from a contracted credit bureau. I understand that I am submitting an application for credit, and am consenting to the use of my credit report information. I authorize any holder of this credit application or any person, firm or corporation requested to extend credit there under, (including any employee or agent of any of them) to communicate with my employer in order to verify my employment. I authorize any holder of the Retail Installation Contract, the creditor thereof, or any Attorney, debt collector or collection agency to communicating any and all information concerning this application or debt to any credit reporting agency or other creditor. By providing my email address, I consent to receive electronic information such as monthly billing reminders, statements and collection notices. I also acknowledge that you and your partners may use all contact information provided to contact me regarding this application, loan offer, account status or future issues. You may utilize electronic, mobile, autodialed messages, SMS or traditional methods. I futher acknowledge and agree, that I will notify the creditor or prospective creditor in writing of any change in my name, address or employment within a responsible time thereafter.
Married Wisconsin Residents: No provision of any marital property agreement, a unilateral statement under Wis. Statute Section 766.59 or a court decree under Section 766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished with a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.
By checking this box (1) you authorize LendingYard.com to forward your application,
including your nonpublic personal information, to other companies for consideration
of your qualification for a loan product; (2) you consent that we may share the
information you provide to us with other companies to receive products or services
we believe may be of interest to you; and (3) you acknowledge you have reviewed
be found at https://secure.lendingyard.com/secure/privacy.aspx
Electronic Signature Agreement. By selecting the "I Accept" button, you are signing
this Agreement electronically. You agree your electronic signature is the legal
equivalent of your manual signature on this Agreement. By selecting "I Accept" you
consent to be legally bound by this Agreement's terms and conditions. You further
agree that your use of a key pad, mouse or other device to select an item, button,
icon or similar act/action, or to otherwise provide LendingYard.com, or in accessing
or making any transaction regarding any agreement, acknowledgement, consent terms,
disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"),
acceptance and agreement as if actually signed by you in writing. You also agree
that no certification authority or other third party verification is necessary to
validate your E-Signature and that the lack of such certification or third party
verification will not in any way affect the enforceability of your E-Signature or
any resulting contract between you and LendingYard.com. You also represent that
you are authorized to enter into this Agreement for all persons who own or are authorized
to access any of your accounts and that such persons will be bound by the terms
of this Agreement. You further agree that each use of your E-Signature in obtaining
a LendingYard.com service constitutes your agreement to be bound by the terms and
conditions of the LendingYard.com Disclosures and Agreements as they exist on the
date of your E-Signature.
The Applicant/Additional Applicant hereby acknowledge and recognize that this
is an application for credit. By submitting this application, I(We) have verified
that all information submitted on this application is true and correct to the best
of our knowledge, as well as allowing LendingYard.com, and/or its Lender(s)
and other 3rd Parties to verify the enclosed information, including, but not limited
to, obtaining our credit reports, contacting our employers to verify employment
and income, and/or contacting our Physician to verify the type of procedure(s),
procedure date, deposit amount, procedure amount, and remit payment upon approval.
I(We) understand and agree that the Lender(s) [as defined in the Promissory Note
or communicated to me] can furnish information concerning my/our account to consumer
reporting agencies and others who may properly receive that information. By providing
a telephone number for a cellular phone or other wireless device, I(We) are expressly
consenting to receiving communications at that number, including, but not limited
to, prerecorded voice message calls, text messages, and calls made by any representatives
from LendingYard.com and/or its Lender(s) and other 3rd Parties. This
express consent applies to each such telephone number that I(We) provide to LendingYard.com
and/or its Lender(s) now or in the future and permits such calls
regardless of their purpose. These calls and messages may incur access fees from
my/our cellular provider. I(We) understand that we may opt out of this authorization
by providing written notice to the parties herein. If approved for a revolving account,
a credit card will be issued in either the Applicant or Additional Applicant's name
only, and it will be sent to the home address on the application. APR’s will vary
depending upon credit ratings and/or payment terms that are approved. Credit approvals
are valid for a limited time only. Certain fees may apply. By signing, I(We) certify
that I(We) have read, agree to, and understand the disclosures herein and I(We)
agree to the terms of this application and that a physician staff member may apply
on our behalf.