Pre-Qualification Questionnaire
Are you currently unemployed or receiving state benefits?
Do you have multiple collection accounts or numerous late payments?


Have you had any recent late payments on your mortgage?
Have you declared bankrupt in the last 7 years?
Do you have at least 2 years of established credit?
Are you a US citizen or eligible permenant-based resident?
Is your credit score below 650?
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?
Is your debt to income ratio higher than 42%?
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)

If you have completed the prequalification questionnaire and are satisfied that you will qualify for a FreedomLoan, please complete the following application form.

IMPORTANT
Please provide accurate and verifiable information as you will be required to substantiate your application with supporting documents which may include, but not limited to recent pay stubs, previous year tax return, rental agreement, employment confirmation, etc.


APPLICATION FORM
ABOUT THE TREATMENT
Treatment Facility  : please specify Name of Treatment Provider (DO NOT ENTER INSURANCE CARRIER)
Type of Service   :
Specify   : if other
Loan Amount   : total amount of treatment
Down Payment (if any)   : if applicable
LEAD APPLICANT - ABOUT YOU
First Name   :
Last Name   :
SSN   : format xxxxxxxxx
DoB   : format mm/dd/yyyy
Email   :
Phone   : format xxxxxxxxxx
Cellphone   : format xxxxxxxxxx
Street   :
City   :
State   : leave blank if outside the US
Zip Code   : or postal code
Home Status   :
Mortgage/ Rent Payment   : no commas
Years/ Months at Residence   : format yy.mm
Mortgage Company   :
Home Value   : full amount - no commas
Complete this section if you have lived at your address for less than 2 years
Previous Address   : full address
Yr/ Mo at Previous Home   : format yy.mm
ABOUT YOUR EMPLOYMENT
Current Employer   : full legal name
Occupation   :
City/ State   :
Yr/ Mo at Current Employer   : format yy.mm
Work Phone   : format xxxxxxxxxx
Complete this section if your current employment is less than 2 years
Previous Employer   : full legal name
Previous Work Tel   : format xxxxxxxxxx
Yr/ Mo at Previous Employer   : format yy.mm
PERSONAL INFORMATION
Gross Monthly Salary   : full amount - this will be verified
Other Monthly Income   : full amount - this will be verified
Source of Other Income   : this will be verified
Have you declared bankrupt   :
Date Filed   : format mm/yyyy
Savings Account   :
Checking Account   :
Bank Name   :
CO-SIGNER INFORMATION
Relationship to Lead   :
First Name   :
Last Name   :
SSN   : format xxxxxxxxx
Date of Birth   : format mm/dd/yyyy
Phone   : format xxxxxxxxxx
Cellphone   : format xxxxxxxxxx
Street   :
City   :
State   : leave blank if outside of the US
Zip Code   :
Current Employer   : full legal name
City/ State   :
Occupation   :
Work Phone   : format xxxxxxxxxx
Yr/ Mo at Employer   : format yy.mm
Gross Monthly Salary   : full amount - this will be verified
Other Monthly income   : full amount - this will be verified
Source of Other Income   : this will be verified
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   :