Loan Application Form LOAN APPLICATION FORMLoan DetailsPlease enter the amount of money you want to borrowYou are applying for?*LoanMortgageAmount*Between $1,000 and $50,000Please enter the amount of money you want to borrow. Select Amount to borrow*Select$300$400$500$600$700$800$900$1,000What is the reason for your loan?*Credit Score*Don’t know your credit score? Go to creditkarma.ca. Don’t know your credit score? Go to creditkarma.ca. Personal InformationPlease fill up your personal information belowFirst Name*Phone Number xxx-xxx-xxxx*XXX-XXX-XXXXAddress*Last Name*Date of Birth*Postal Code*Example: H1H 1H1Email address*Choose your provinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonInformationMarital Status?SingleMarriedDivorcedCommon lawMarital StatusMarried InformationSpouse Fullname*Spouse Date of Birth*Does Your Spouse Work?YesNoDoes Your Spouse Work?What’s Your Spouse Occupation?What’s your Spouse’s Gross Annual salary?What’s Your Spouse Credit Score?*Spouse Employer Name*Dependent(s) InformationDo you have any Dependent(s)? *Please selectYesNoDependent(s) InformationHow Many Dependent(s)?*Do you receive child benefits?*Please selectYesNoWhat’s your monthly child benefits?*EmploymentAre you Currently Employed*Please selectYesNoJob Sector*Please selectAccountancy, Banking & Finance.Business, Consulting & Management.ConstructionWholesale & RetailCreative Arts & Design.Energy & UtilitiesEngineering & ManufacturingEnvironment & AgricultureHealthcareEducationOtherOther Job Sector Name*Current Employer Name*Job Title*How you get paid?*Please selectDirect DepositChequeAnnual Gross Income*Employer Phone Number*How long have you been working at your present work?*Complete address of the office where you’re working*Select Previous Employment? YesNoPrevious Employment? How long did you work at your previous work?*Previous Employer Name*Residence InformationHousing Status*Please selectRentingHomeownerHow long have you been living at your current address?*How long have you been living at your current address?*What is your rent per month?*What is your monthly mortgage payment?*Own Vehicle?Do you own a vehicle?*Please selectYesNoAmount Owning on a Car*Collateral is Required for “Secured Loans”Vehicle InformationVehicle YearYear of your vehicleMakeCompany of the vehicleSelect MakeAcuraAudiBMWBuickCadillacChevroletChryslerDodgeFiatFordGMCHondaHummerHyundaiInfinitiJaguarJeepKiaLand RoverLexusLincolnMaseratiMazdaMercedes-BenzMercuryMiniMitsubishiNissanOldsmobilePontiacPorscheRamSaabSaturnScionSmartSubaruSuzukiToyotaVolkswagonVolvoOtherModelKilometersEnter the Approximate Kilometers on your vehicleValueVIN NumberWhen did you buy it?*How much did you buy it for?*Condition*Please selectNewUsedVehicle Paid Out?*Is your vehicle clear of any liens or loans?SelectYesNoCredit Score*Don’t know your credit score? Go to creditkarma.ca.Don’t know your credit score? Go to creditkarma.ca.Balance on Vehicle?–YesNoWhen Balance Paid in Full?*When Balance Paid in Full?Remaining balance to pay*How much was your original car loan amount?*Upload DocumentsDocument’s required: vehicle’s registration, Insurance and 2-pieces of photo government-IDsDo you own other assets?*Please selectYesNo(If you own multiple assets, you can choose more than one asset)Home OwnerMobile Home OwnerTrailer OwnerLand OwnerOtherAppraised JewelryCollectible coinsGold BulionWatchesAntique Collectible CarCheck which you haveOther Asset’s Name*Upload DocumentsDocument’s required: registration, Insurance and 2-pieces of photo government-IDsYour Asset(s) Info:HomeHome Assessment ValueMortgage balance*Mortgage balance 2*Purchase Price*Date of Purchase*Date of PurchaseUpload DocumentsDocument’s required: registration, Insurance and 2-pieces of photo government-IDsAdditional Information for Home OwnerName of Mortgage 1Interest Rate of 1st mortgageMortgage Balance 2Year it was built?TaxesNumber of Stories12345678ElevatorsSelectYesNoPorchBedrooms12345678910Square FootageRecent RenovationSelectYesNoMortgage Balance 1Name of Mortgage 2Interest Rate of 2nd mortgageProperty TypeSelect TypeCondoCo-OpSingleMultiMonthly MaintenanceYear Built?Management CompanyGarage/Parking SpaceBaths12345678910ConditionRenovation DetailsWallsRenovation DateRenovation DetailsWindowsRenovation DateRenovation DetailsRoofRenovation DateRenovation DetailsBathroomRenovation DateRenovation DetailsKitchenRenovation DateRenovation DetailsFloorRenovation DateRenovation DetailsDeckRenovation DateRenovation DetailsOther RenovationsRenovation DateRenovation DetailsMobile HomeMunicipal valueMortgage balancePurchase priceDate of Purchase*YearYear of your mobile homeMake Manufacturer of your mobile homeModelLocated OnSelect OptionRented LandMobile Home ParkOwn LandUpload DocumentsDocument’s required: registration, Insurance and 2-pieces of photo government-IDsLand Owner’s NameLand Owner’s Phone NumberLand Owner’s AddressMobile Home Park NameMobile Home Park AddressMobile Home Park Phone NumberMobile Home Park ManagerHow many units are in the park?Municipal ValueMortgage BalancePurchase PriceDate of PurchaseDate of PurchaseTrailerYearYear of your trailerMakeCompany of your trailerModelSlidesValueTrailer Paid OutPlease selectYesNoUpload DocumentsDocument’s required: registration, Insurance and 2-pieces of photo government-IDsLandMunicipal valueMortgage balancePurchase priceDate of PurchaseUpload DocumentsDocument’s required: registration, Insurance and 2-pieces of photo government-IDsReferral ByNameEmailPhoneHow did you hear about BHM Financial?*Please selectGoogleSocial MediaSocial Media*Please selectFacebookTwitterLinkedInOtherSocial Media ID*example: facebook.com/yourid or twitter.com/youridYes, I would like to receive a quote on how much CASH I can get on my Title Loan as well as information on other products and/or services from and its affiliates via text message and email. By making this selection, I understand and agree I will receive text messages at the mobile number provided. I know my selection is not necessary to apply for and/or use services.By applying I agree to BHM Financial Group’s Wireless Policy, Privacy Policy & Terms & ConditionsSubmit & ContinueThis field should be left blank
