SerenityLoan Application

SerenityLoans is a unique behavioral health loan program available to people that require financial assistance to help pay for services throughout the continuum of care however, application approval is based on your credit score, current debt to income ratio and many other factors. To help us better serve you, please complete the following pre-qualification questionnaire.

Pre-Qualification Questionnaire

Are you currently unemployed or receiving state benefits?	Yes No
Do you have multiple collection accounts or numerous late payments?	Yes No
Have you had any recent late payments on your mortgage?	Yes No
Have you declared bankrupt in the last 7 years?	Yes No
Do you have at least 2 years of established credit?	Yes No
Are you a US citizen or eligible permenant-based resident?	Yes No
Is your credit score below 680?	Yes No Unsure
Do you have documentation to prove your income (pay stubs, tax returns, and a divorce decree for any alimony or child support)? If you are self employed do you have your most recent 2 years tax returns complete and does your AGI (line37 on tax return) match the income on your application?	Yes No Unsure
Is your debt to income ratio higher than 42%?	Yes No Unsure

Debt to Income RatioCalculator (in months)

Lead Applicant Gross Monthly Income (do not include spouse income)		Monthly Mortgage or Rent Payment (do not include household expenses or utility bills)
Total Other Monthly Verifiable Income (eg child support, alimony, bonuses, rentals)		Total Monthly Installment Loan Payments
Co-Signer Gross Monthly Income (do not include spouse income)		Total Monthly Credit Card/ Store Card Payments
Co-Signer Other Monthly Verifiable Income		Total Monthly Auto Loan Payments
		% (Please answer DTI question above)

SERENITYLOAN APPLICATION
ABOUT THE TREATMENT
Medical Provider :
Type of Service :
Specify :
Loan Amount :
Down Payment (if any) :
LEAD APPLICANT - ABOUT YOU
First Name :
Last Name :
SSN :
DoB :
Email :
Phone :
Cellphone :
Street :
City :
State :
Zip Code :
Home Status :
Mortgage/ Rent Payment :
Years/ Months at Residence :
Mortgage Company :
Home Value :
Complete this section if you have lived at your address for less than 2 years
Previous Address :
Yr/ Mo at Previous Home :
ABOUT YOUR EMPLOYMENT
Current Employer :
Occupation :
City/ State :
Yr/ Mo at Current Employer :
Work Phone :
Complete this section if your current employment is less than 2 years
Previous Employer :
Previous Work Tel :
Yr/ Mo at Previous Employer :
PERSONAL INFORMATION
Gross Monthly Salary :
Other Monthly Income :
Source of Other Income :
Have you declared bankrupt :
Date Filed :
Savings Account :
Checking Account :
Bank Name :
CO-SIGNER INFORMATION
Relationship to Lead :
First Name :
Last Name :
SSN :
Date of Birth :
Phone :
Cellphone :
Street :
City :
State :
Zip Code :
Current Employer :
City/ State :
Occupation :
Work Phone :
Yr/ Mo at Employer :
Gross Monthly Salary :
Other Monthly income :
Source of Other Income :
By clicking Submit, I authorize Freedom Consultancy ("the Loan Advisor") to check my credit references and to obtain and use consumer reports (i.e. credit reports) on my credit history in connection with my Loan Application and in connection with any update, renewal or extension of credit for which I have applied. If I request, I will be informed whether or not consumer reports are obtained, as well as the names and addresses of the consumer reporting agencies (i.e. credit bureaus) that furnish the reports. I further authorize the Loan Advisor to provide information regarding the status of my transaction to the Medical Provider listed above. I authorize the Medical Provider listed above to release to the Loan Advisor, the lending institution, its agents, subsequent holder of the loan and its agents, any requested information pertinent to this Loan Application, including but not limited to, employment, enrollment status, prior loan history and my current address. I agree to refer to my Promissory Note for notices to California, Ohio and Wisconsin residents. Even if I have elected to opt out of information sharing or do so in the future, I understand and agree that this consent authorizes the Loan Advisor to share my information for purposes of processing this Loan Application and servicing any resulting loan. I have completed this Loan Application to obtain credit and, by Clicking Submit, certify that the above statements are true and complete.
Lead: Agree to Terms :
Co-Signer: Agree to Terms :