Phone: (800) 708-0208
Fax: (818) 465-0134
www.myLegalLoan.com

 

Loan Application


Contact Information



First Name:
Last Name:
Date of Birth:
Social Security Number:
Daytime Phone:
Alternate Phone:
Best time to Call:
Email Address:
Home Address:
City:
State:
Zip:
How long at this address?
  Own    Rent
Monthly mortgage or rental payment:

Case Information



Type of Case:
Financing Amount Requested:
Referring Attorney:
Prior Criminal Record? Yes    No
(If Yes, please provide description in comments section.)

Current Employer



Employer Name:
Employer Phone:
How long at this job:
Position:

Current Income Verification



Gross monthly income from job:
Monthly income from other sources:
Source of other Income:
I have a Checking Account Yes    No
I have a Saving Account Yes    No
Do you have a Co-signer if needed? Yes    No
Comment:

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Khashayar Law Group • 400 S. Melrose drive Suite 209 • Vista (San Diego), CA 92081
Toll Free: 866-567-6458 • Local: (760) 806-4388 • Fax: (760) 806-4357
 
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