GENERAL LOAN APPLICATION APPLICANT PERSONAL INFORMATIONName* First Last Hebrew Name*Date of Birth* MM slash DD slash YYYY Cell Phone Number*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Residing at address since* MM slash DD slash YYYY In Austin or the surrounding area since* MM slash DD slash YYYY Indicate your relationship to the Jewish community.* I am Jewish. My spouse/partner is Jewish. I am not Jewish, but I work for a Jewish communal agency. I am not Jewish and have no connection to the Jewish Community. Name of Jewish Agency you work for:*US Citizen or Legal Resident?* Yes No How did you hear about HFLA?*Please selectRabbiCongregationJewish OutlookShalom Austin digital adsHillel, Chabad, or other Jewish organizationSearch engineFacebookFriend or FamilyOtherLocal Synagogue affiliation, if any*Agudas AchimBeth ElBeth IsraelBeth ShalomChabadTiferet IsraelOtherUnaffiliated JewishUnaffiliated Not-JewishSpecify anyone (person or organization) who referred you to HFLA:If Other, please give detailsFAMILY INFORMATIONApplicant's Marital Status* SINGLE MARRIED DIVORCED SEPARATED WIDOWED Spouse's Name* First Last Spouse's Email* LOAN INFORMATIONHave you received an interest-free loan before?* I am a first-time HFLA Applicant. I am currently paying towards an HFLA loan. I have paid off a previous loan from HFLA. I have received a loan from another Hebrew Free Loan agency. I have guaranteed a loan but not applied for one myself. Amount Requested*(Up to $7,500 with Guarantor)General Purpose of Loan (i.e. debt, medical, home repairs, etc.)*More specifically, how will you use the loan money?*GUARANTOR* INFORMATION(*To qualify for a loan greater than $1,000, Guarantor must be someone different from Borrower. See FAQ for more information.)Name of Guarantor* First Last Guarantor's Relationship to Applicant*cannot be self or spouseGuarantor Cell Phone Number*Guarantor's Email* EMERGENCY CONTACTYour emergency contact will not be used for collections. This person(s) has your permission to discuss loan and payment details with HFLA in the event of an emergency.Emergency Contact 1* First Last Relationship of Emergency Contact 1*Cell # of Emergency Contact 1*Emergency Contact 2 First Last Relationship of Emergency Contact 2Cell # of Emergency Contact 2BANKING & EQUITYBank Name*Amounts HeldCheckingSavingsEstimated value of car(s)Equity on propertyStocks, Mutual Funds, or other investments excluding 401kAPPLICANT EMPLOYMENT & INCOMEApplicant's Occupation*Name of Employer*Employed Since MM slash DD slash YYYY Business Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Business PhoneTake-home Pay (after taxes) per month*SPOUSE EMPLOYMENT & INCOME(if applicable)Spouse's OccupationName of Spouse's EmployerSpouse Take-home Pay (after taxes) per monthSpouse Employed since MM slash DD slash YYYY TOTAL INCOMEOther Income Listed (alimony, retirement pension, child support, etc)$ Total OTHER INCOME From Above*Total Monthly Household Net Incometake-home pay + other incomeMONTHLY EXPENSESMarried or partnered applicants should report joint household expenses.Rent/Mortgage*Food*Utilities*Telephone, internet and cable*Medical Insurance (if applicable)*Recreation/Entertainment*Car Expenses (i.e. insurance, gas, maintenance)*Car Payments (if applicable)*How many months remaining on car payments?Other Monthly Expenses (synagogue dues, entertainment, subscriptions, school tuition, etc.)$ Total OTHER EXPENSES from Above*(enter 0 if not applicable)Dependent(s) Care Expenses (daycare/preschool, private school, religious school, after care, child support)Total Monthly ExpensesMONTHLY NET=Total Net Income MINUS Total Monthly ExpensesMonthly NetDEBT*Please note all applicants are required to submit a free credit report.Credit Card Balance(s)*For each credit card, please list (1) name (2) balance and (3) how much you pay monthly.Total Credit Card Debt*Approximate Monthly Credit Card Payment*Student LoansOther Debt: Please list name of creditor, type of debt, amount, monthly payment and date last paid. (i.e. line of credit, personal loan)* Have you ever filed for bankruptcy?* Yes No Required Supportive Documentation for Applicants1. Copy of your driver's license (or other valid picture ID) 2. Most recent employer pay stub 3. Most recent W-2 4. Free Credit Score (showing your name) 5. 2 most recent months' bank statementsUpload as many of the following documents of support that you have available.Please email all remaining documents to loans@hfla.org as soon as possible.1. Driver's license (or other valid picture ID) - front onlyMax. file size: 50 MB. 4. Credit Score (showing your name)Max. file size: 50 MB. 2. Most recent employer pay stubMax. file size: 50 MB. 5. Recent Bank Statement Month 1Max. file size: 50 MB. 3. Most recent W-2Max. file size: 50 MB. 6. Recent Bank Statement Month 2Max. file size: 50 MB. Please explain how you will have the monthly resources to make the loan payments to HFLA.*The undersigned hereby certifies that the information provided is true, correct and complete. HFLA is authorized to make inquiries and gather information that it feels is necessary concerning statements made on this application. It is further agreed that HFLA will be promptly notified of any material changes in this information.Applicant's Name* First Last Consent* I agree to the terms of this application and loan.Today's Date* MM slash DD slash YYYY CAPTCHA Δ CONTACT US "*" indicates required fields Name* First Last Email* Phone*Type 4-Letter Acronym "HFLA"*Message*CAPTCHA Δ
