Micro Loan Application

Maximum: 1 Applicant / 1 Loan per HouseholdMaximum Loan: $350

1Loan Details

Amount Requested (Maximum $350)

Brief Description of Your Situation

Purpose of Loan (intended use of funds)

Requested Repayment Term

1 Month2 Months3 Months

2Applicant Information

First Name

Last Name

Marital Status

Home Address

City

State

ZIP Code

Length of Time at Current Address

Cell Phone Number

Email Address

Driver's License (photo required)

Upload photo of your license

3Community / Shul Information

Shul Affiliation

Rabbi Name

Rabbi Phone Number

4Banking & Disbursement Information

Bank Name

Routing Number

Account Number

Zelle (if approved loan will be sent here)

5Repayment Information

A 24-48 hour authorization hold will be placed to verify validity

Name on Card

Card Number

Expiry Date

CVV

Authorization & Agreement: I understand and agree that if the loan is not repaid by the due date, my credit card will be charged 10% of the original loan amount weekly until the balance is paid in full.

I Agree

6Co-Signer Information

Application will be sent to co-signer for electronic signature

Co-Signer Name

Relationship to Borrower

Co-Signer Email Address

Your information is secure and will only be used to process your loan application.