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Loan Application

* Required Fields



    • Are you interested in having your loan protected in the event of death or disability:


    • I request the following on this loan:


    • OR

    • OR


    • THIS MUST BE COMPLETED IN FULL BEFORE IT CAN BE PROCESSED.
    • Part 1 - About Me



    • * Birthdate
      / /
    • Status







    • Best Contact Number
      ( ) - ext
    • Employer
    • * Employer



    • Date of Employment
      / /



    • Work Phone or Avista Ext.
      ( ) - ext
    • Part 2 - About Spouse/Co-Applicant


    • Birthdate
      / /





    • Date of Employment
      / /
    • Best Contact Number
      ( ) - ext

    • Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
    • Other Income


    • Part 3 - Credit Information


    • Do You:




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