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First Name *
Last Name *
Address - Street *
City, State and Zip *
Date of Birth *
Social Security Number *
Married, Single, Divorced or Seperated *
How many dependent children do you have ? *
Amount requesting to borrow. Range is from $50.00 to $1400.00 *
What is your purpose for the loan? *
Home Phone Number (if no land line, enter cel phone on next question) *
Cel Phone Number with area code *
Housing:renting, buying, or other? *
How much is your house payment or rent? *
How long have you been at your address: years/months *
Employer Name - *
How long have you been employed there? *
How often do you get paid? *
How much is each paycheck NET (take home) *
What is your work phone number? *
What is your work phone extention? *
Do you receive any alimony or child support (you do not have to answer this)
If yes, how much alimony/child support do you recieve monthly
Do you pay any alimony or child support? *
If yes, how much to you pay a month ? Enter zero if no. *
List other loans and credit cards you have. If none, enter zero *
Do you have a checking account? *
Is your income direct deposit? *
Have you ever filed bankruptcy? *
List any other income not listed in employer section (2nd job, social security, disability etc)
Total amount of other income
How often do your receive your other income?
Everything that I have entered on this application is correct to the best of my knowledge. I understand that you will retain this application whether it is approved or not. You are authorized to check my credit and employment history. I understand by entering my name and information, I am electronically signing this application. Yukon Finance does not share information. All information is confidential. I understand I will be contacted through the e-mail address I have provided on this application as to whether I am approved or not. Please enter your first and last name to sign your application. *
Email address *

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