Keren Dina Gemach
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Micro Loan Application
Maximum: 1 Applicant / 1 Loan per Household
Maximum Loan: $550
1
Loan Details
Amount Requested
(Maximum $550)
$
Brief Description of Your Situation
Purpose of Loan
(intended use of funds)
Requested Repayment Term
1 Month
2 Months
3 Months
2
Applicant Information
First Name
Last Name
Marital Status
Single
Engaged
Married
Divorced
Single Parent
Home Address
City
State
ZIP Code
Length of Time at Current Address
Cell Phone Number
Email Address
Driver's License
(photo required)
Click to upload photo of your license
3
Community / Shul Information
Shul Affiliation
Rabbi Name
Rabbi Phone Number
4
Banking & Disbursement Information
Zelle Email or Phone
(if approved loan will be sent here)
Submit Application
Your information is secure and will only be used to process your loan application.