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Loan Information
Total Amount of Loan: Reason for Loan:

Credit Information
Your Credit: Co-Applicant Credit:
Excellent - 700 Credit Score or better
Good - 650 to 699 Credit Score
Fair - 630 to 649 Credit Score
Poor- 600 to 629 Credit Score

Service Information
Provider Name: Paul Rollins

Applicant Information
First Name: MI: Last Name: Mother's Maiden Name:
SSN: Date of Birth:
 -   -   /   / 

Email: No Email
Current Address: (Cannot contain PO Box)

City: State: Zip:
Time at Current Address:
Years Months

Housing: Monthly Rent/Mortgage: Numbers only (e.g. 1000)
Estimated Property Value: Current Mortgage Balance:
Home Phone: Alternate/Cell Phone:

Drivers License State: Drivers License #:
Employer Information
Employer Name: Position: Income: Numbers only (e.g. 35000)
Employer Address:

City: State: Zip:
Time at Current Employer:
Years Months

Business Phone:
Other Income: Numbers only (e.g. 35000) Source of Other Income:

Secured Loan (Optional)
If required, would you use your home as collateral?
If yes, please fill out the Estimated Property Value and Current Mortgage Balance fields and if 2 people are listed on the house, please fill out Co-Applicant information.

By submitting my application, I authorize "Med Loan Finance", a loan processing company and / or their affiliated lending partners to run a credit report and verify the information I have provided. I understand "Med Loan Finance" will be acting as a Fee Based credit-processing agent on my behalf and therefore does not approve, deny, set the rate and terms, guarantee loan approvals or discriminate against anyone for any reason. As a part of this search, I fully understand my credit request may be presented to multiple credit issuing companies and/or search companies including (but not limited to) Banks, Finance Companies, Credit Card Issuers, and partnership programs with other such affiliated companies. I understand that I will be charged loan processing fees for these services. Furthermore, while calculated monthly, I understand that the total amount of the fees will be added to my base loan amount requested and become a part of my principal balance in most cases. I agree to "hold harmless" "Med Loan Finance" from any and all legal actions that might be taken as a result of a disputed matter with my Service Provider or Vendor.

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