EmailMe Form - KWCI Dental and Medical Surgery Loans

Name *

First Last

Email *

Phone *

### - ### - ####

What is the purpose for your loan? *

What amount of funding ($) are you requesting? *

Are you a U.S. Citizen? *

Yes

No

Permanent Resident

Are you a resident of the state of California or Iowa? *

Yes

No

Is your age 72 years old or younger? *

Yes

No

Do you have a credit score of 700 or higher? *

Yes

No

Have you opened any New Personal Credit in the last 6 months? *

Yes

No

Have you had no more than 6 hard inquiries during the last 6 months? *

Yes

No

Do you have at least three Active Trade Lines on your credit profile? *

Yes

No

Have your credit card balances been below 60% for the last 90 days? *

Yes

No

Have you had any Late Payments, Collections, Charge-Offs, Judgements, Evictions, Car Repossession, Tax Liens, Delinquent Child Support, Foreclosures, Pre-Foreclosure, Delinquent Medical Bills reported on your credit in the last 2 years? *

Yes

No

Have you ever filed Bankruptcy? *

Yes

No

If you have filed for Bankruptcy has it been discharged for 2 years or more? *

Yes

No

N/A

Have you had any Credit Repair performed recently? *

Yes

No

N/A

Do you currently have any fraud alerts on your credit report? *

Yes

No

Are you employed or self-employed? *

Full time employee

Self-employed only

Employed and also own a business

I am retired

If employed with W-2 or 1099, are you earning a minimum of $46,800 per year on your current job and working there for the last 6 months with no breaks in employment for the last 12 months? *

Yes

No

N/A

If self-employed have you been in business 2 years or more and grossed $50,000/year with an AGI of $46,800/year or more each year? Is this verifiable with your last two years of tax returns? *

Yes

No

N/A

Are you currently on any paid leave of absence with your employer? *

Yes

No

N/A

If retired, disabled or receiving Social Security, do you have an awards letter? *

Yes

No

N/A

{So tell us....}

How did you hear about us? *

Referral Name

First Last

Referral Company Name