Helping Families in the Midwest
Reach New Heights since 1992!

We specialize in helping individuals that do not qualify for traditional retail finance programs. We make it a regular practice of lending to people with previous credit problems, tight budgets and past bankruptcies.

Over 100 Branch Offices to
Serve You in the Midwest

 

The following branch can service your lending needs...

Address:
1315 Hwy 24 East, Suite C
Moberly, MO 65270

Branch Manager: Tina Gibler
Phone: (660) 263-9213

Go back to branch information


APPLICANT: Please read the following before completing this form. Please check the box which identifies the type of credit you are applying for. Married applicants may apply for an individual account.

I am applying for:


INDIVIDUAL CREDIT
INDIVIDUAL CREDIT but relying on income or assets of another person as a basis for repaying the credit requested.
JOINT CREDIT we intend to apply for joint credit.

*All fields are required for completion of application.

Loan Application


Date: 08/01/15

Purpose of Loan:  If other, please describe:

Promotion Code:

Amount of Loan: $

First Name:  M.I.:  Last Name:

Social Security Number:  Date of Birth: / /

Marital Status: Do not complete if this is an application for individual unsecured credit

Number of Dependents:

Current Address:

City:  State:  Zip Code:

How Long have you lived at the current address:  Years  Months

Home Phone:

Email Address:  Confirm Email:

Housing Status: Renting Buying Own

Housing Type: Apartment Mobile Home Home

Employer's Name:  Self-Employed: Yes No

Employment Type:

Your Position:  Employer's Phone:

Length of Employment: Years Months

Net Income: $

Additional Income: 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.
Describe:   Amount: $

Vehicles Owned:

Make Year Model Financed By

I do not own a vehicle

Joint Application information

Copy address information from above.

Relationship to Applicant:

First Name:  M.I.:  Last Name:

Social Security Number:  Date of Birth: / /

Current Address:

City:  State:  Zip Code:

How long have they lived at the current address:  Years  Months

Home Phone:

Email Address:  Confirm Email:

Currently Employed: Yes No

Employer's Name: Self-Employed: Yes No

Employment Type:

Position:  Employer's Phone:

Length of Employment: Years Months

Net Income: $

Additional Income: 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.
Describe: Amount: $


Loan Information Section

Mortgage Balances:

Amount Held By Payment
First
Second
Other

I have no other debt

Creditors Amount Owed Monthly Payment Can we pay this off?
Yes No
Yes No
Yes No
Yes No
I have additional outstanding creditors
Have you filed bankruptcy in the past? Yes No  If yes, what year?

Rent Amount: $  Landlord:  Phone:


Additional Comments:


If physical damage insurance and/or personal property insurance is required in connection with the collateral securing this loan:

I/we can provide proof of insurance at the closing of the loan.
I do not have proof of insurance and I/we will obtain insurance through you or any person of my choice, provided the insurance company is reasonably acceptable to you.


Please provide a phone number and the best time to reach you for questions regarding your application:


Best Time to Reach:

By submitting this Loan Inquiry Form, I/We acknowledge and certify for the purpose of obtaining credit from you and with the intent that you will rely heron and to induce you to extend said credit, that the information given herein is complete, true and correct and at this time I/We fully realize that you are relying upon this to extend credit to me/us. The applicant expressly authorizes Heights Finance Corporation to make inquiries of others concerning the foregoing information and to provide information arising out of the applicant's transactions with you to others. Any person or entity named herein is expressly authorized to furnish you with information in connection with this application.


I/We Agree


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