Consumer Loan Application

QUALIFICATIONS: Applicants must be 18 years of age. Loan applicant must be an enrolled tribal member of a federally recognized Native American Tribe/Alaska Native who resides in our service area (Sonoma, Mendocino, and Lake Counties), or Non-Native Americans who are tribal employees. We can only lend to California residents. We only lend to tribal members whose tribe is in contract with Westwater Financial, Inc.

CONSUMER LOAN Amounts: $2,500 – $10,000 Interest: 10%/12% paid by Tribal General Assistance Payments Loan fee: $50 + 1% over $5,000 Term: 6 to 60 months

CREDIT BUILDER LOAN Amounts: $500 – $5,000 Interest: 10%/12% paid by Per Capita Payments Loan fee: $50 Term: 6 to 36 months

EMERGENCY LOAN Amounts: $500 – $1,500 Term: 10% paid by Per Capita Payments Loan fee: $50 Term: not to exceed 12 months

APPLICATION: 1. Loan applicant must complete ALL of the boxes on the enclosed application.
2. List all “assets & liabilities”. This includes all types of payments made on a monthly basis.
3. Digitally sign and date the application.
4. Attach a copy of your tribal enrollment card.
5. Include most current full month of payroll stubs.
VERIFICATION: 1. Tribal Enrollment may be verified through tribal rolls.
PROCESSING: 1. Return all information to Westwater Financial, Inc. We will review your request and notify you of a decision within 72 hours of receipt of a complete loan application package. Any questions, please call (707) 419-3070.

Please Complete this Consumer Loan Application

Date*
Date Format: MM slash DD slash YYYY
Ethnicity
Tribal # (if Tribal)
LOAN AMOUNT REQUESTED*
Enter the amount of loan you need.
PURPOSE OF LOAN*
TYPE OF LOAN REQUESTED
What type of loan do you need?
DISCLAIMER The information you provide is confidential and is used for funding purposes and to better serve our clients. This information is requested by the Federal Government for certain types of loans, in order to monitor the lender’s compliance with equal credit opportunity. You are not required to furnish this information but are encouraged to do so. A lender may neither discriminate on the basis of this information nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations, this lender is required to note race/ethnicity on the basis of visual observation or surname. If you do not wish to furnish the above information, please below
- I do not wish to provide the information
BORROWER*
Prefix First Name Middle Name Last Name Suffix or Second Last Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Own or Rent?*
How Long?*
Previous Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone No.
Borrower Driver's License Number
Social Security Number:*
Birthdate*
Date Format: MM slash DD slash YYYY
Dependents?*
- Yes
- No
Employer
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position or Title
How Long Employed?
Supervisor Name
First Last
Supervisor Phone No.
Salary per Month - Gross $
Salary per Month - Net $
Type of Work*
Previous Employer
Previous Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Employer Phone No.
Highes Education Completed*
CO-BORROWER
SKIP IF NO CO-BORROWER
CO-BORROWER
Prefix First Name Middle Name Last Name Suffix or Second Last Name
Co-Borrower Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Co-Borrower Own or Rent?
Co-Borrower How Long?
Co-Borrower Previous Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Co-Borrower Cell Phone No.
Co-Borrower Home Phone No.
Co-Borrower Driver's Liense Number
Co-Borrower Social Security No.
Co-Borrower Birthdate
Date Format: MM slash DD slash YYYY
Co-Borrower Dependents?
- Yes
- No
Co-Borrower Employer
Co-Borrower Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Co-Borrower Position or Title
Co-Borrower - How Long Employed?
Co-Borrower - Supervisor Name
First Last
Co-Borrower - Supervisor Phone No.
Co-Borrower - Salary per Month - Gross $
Co-Borrower - Salary per Month - Net $
Co-Borrower - Type of Work
Co-Borrower - Previous Employer
Co-Borrower - Previous Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Co-Borrower - Previous Employer Phone No.
Co-Borrower - Highes Education Completed
NEXT OF KIN
Name, Address, and Phone of nearest relative not living with you*
Their relationship to you*
Name, Address and Phone No. of nearst relative not living with you*
Their relationship to you*
ASSETS
Bank Name:
- Checking Account
- Savings Account
Account No:
Value of Account:
Name(s) in which Account is Carried:
Bank Name:
- Checking
- Savings
Account No:
Value of Account:
Name(s) in which Account is Carried:
Institution Name:
Value of Certificates & Securities:
Name(s) in which Account is Carried:
Real Estate - location date acquired:
Value of Real Estate:
Name(s) in which Account is Carried:
Life Insurance - Issuer:
Face Value
Name(s) in which Account is Carried:
Automobiles - make, model, year:
Current Value:
Name(s) in which Account is Carried:
Other Assets (list):
Value
Name(s) in which Account is Carried
Value
Asset Total
$0.00
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis of repaying this obligation.
Alimony, child support, separate maintenance received under:
Monthly Social Security Income:
Monthly Unemployment:
Monthly Special Needs Program (Per Cap)
OTHER (describe)
Is any income likely to be reduced before the loan request is paid off?
- Yes
- No
Explain why your income would be reduced -
Have you previously received credit from us?*
When did you have your loan with us?
Are you interested in improving your money management skills?*
What types of assistance? (check all that apply)
Describe "Other" assistance requested:
LIABILITIES -
Outstanding Debts / Charge Accts / Installment Contracts / Rents / Credit Cards / Mortgages
Landlord Name and Address:
Monthly Amount $
Past Due Amount $
Mortgage Holder Name & Address:
Monthly Payment Amount $
Current Balance $
Auto (Banklender) Name & Address:
Auto Monthly Amount:
Auto Past Due Amount:
Current Auto Balance Owed:
Credit Card (1)-
Name. Address, Account Number:
Credit card (1) monthly payment:
Past Due Balance (CC-1):
Current Balance (CC-1):
Credit Card (2)-
Name, Address, Account Number
Monthly Payment (CC2):
Past Due Amount (CC-2):
Current Balance (CC-2):
Other Outstanding debt (monthly):
Other Outstanding debt (past due amount):
Other Ourstanding debt (current balance):
Tribal Loan (monthly payment)
Tribal Loan balance:
Total
$0.00
Are you obligated to make Alimony, Support or Maintenance payments?
Amount per month?
If yes, Name & Address
How long will you be making payments
Are you a co-maker, endorser or guarantor on any loan or contract?
Have you co-signed on any debt not listed here?
To Whom did you guarantee?
Have you ever declared bankruptcy or had any judgements recorded against you?
If yes, eplain Chapter, circumstances, and provide date of discharge:
Are you in the process or declaring bankruptcy at this time:*
Upload Required Documents*
Upload required Tribal Card and Driver's License or other valid ID, and 3 Payroll stubs
Drop files here or

Accepted file types: jpg, gif, png, pdf.
By submitting this document I certify that everything stated in this application and on any attachments is correct. By submitting I further authorize you to check my credit and employment history and to answer questions others may ask me about my credit record. I understand that I must update credit information at your request if my financial condition changes. All costs, fees, and expenses of collection and/or litigation will be assessed the "Borrower: and added to the balance of the loan.
I agree to the statement above:*
- Yes
- No
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Consumer Loan Application

Please Complete this Consumer Loan Application

CO-BORROWER

NEXT OF KIN

ASSETS

LIABILITIES -