Member Area

First Name Primer nombre *

Last Name Apellido *

SSN SSN *

- -

E-mail Correo electrónico *

Birth Date Fecha de nacimiento *

Valid Driver's License or State ID Number Numero de licencia *

State Issued Estado *

Home Phone Teléfono de casa *

Cell Phone Numero de celular *

Best Time To Call La mejor hora de contacto

Address Dirección *

City Ciudad *

State Estado *

Zip Código postal *

Time At Address Tiempo en residencia *

Own/Rent Esta rentando o poseeуn *

RentOwn

Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to sign one of the following statements as applicable: La ley federal ofrece protections importantes a los miembros activos de las fuerzas armadas y sus dependientes. Para aseguramos de que estas protectiones sean dadas a aplicantes elegibles, requerimos que firme una de las siguientes lineas: *

Yes

I AM a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer.

Soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30 dias o mas.

- or -

I AM a dependent of a member of the Armed Forces on active duty as described above, because I am the member's spouse, the member's child under the age of eighteen years old, or I am an individual for whom the member provided more than one-half of my financial support for 180 days immediately preceding today's date.

Soy un dependiente de un miembro de las Fuerzas Armadas sirviendo actualmente como lo explique arriba porque soy esposa (o) de un miembro, el hijo del miembro es menor de dieciocho años, o un sujeto para quien el miembro le mas de la mitad de apoyo financiero por 180 dias a partir de hoy.

I AM NOT a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer (or a dependent of such a member).

No soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30 dias o mas (o un dependiente de tal miembro).

Yes, please send me account-related messages such as payment reminders to the cell phone number provided

Sí, envíeme mensajes relacionados con la cuenta, como recordatorios de pago, al número de teléfono celular proporcionado

Yes, please send me promotional messages to the cell phone number provided. Opting in for promotional messages is not a requirement to receive the services you’ve requested from Lifeline Lending, LLC. Promotional messages will be sent to approved carriers only.

Sí, por favor envíame mensajes promocionales al número de celular proporcionado. Optar por recibir mensajes promocionales no es un requisito para recibir los servicios que ha solicitado de Lifeline Lending, LLC. Los mensajes promocionales se enviarán únicamente a operadores aprobados.

By checking the above, you are opting in to receive SMS text messages from Lifeline Lending, LLC. Message and data rates may apply. Message frequency will vary. To opt-out at any time, reply STOP to any message we send, or HELP for more information. Al marcar lo anterior, usted opta por recibir mensajes de texto SMS de Lifeline Lending, LLC. Se pueden aplicar tarifas por mensajes y datos. La frecuencia de los mensajes variará. Para cancelar su participación en cualquier momento, responda DETENER a cualquier mensaje que le enviemos o AYUDA para obtener más información. Texto

Disclosures - Yes is required

Yes No

Credit Authorization - By selecting "YES", you authorize us to obtain consumer reports in order to evaluate your application for credit or collect your account. You authorize the reporting of all credit history relating to all consumer reporting agencies including credit bureaus and specialty agencies as allowed by law for any credit transaction you obtain at the time of this application or at any time thereafter, including but not limited to any refinancing of a credit transaction, and any subsequent new transactions. You agree that we may obtain subsequent consumer reports in connection with an update, renewal or extension of credit, or any review or collection of credit, without further notice, and you authorize all such consumer reports. *

Yes No

Account Transaction Calls – Auto-dialers, Prerecorded Voice and Text Messages to Your Residential Phone and Your Cell Phone. Receipt of residential and cell phone calls (including text messages) may be subject to charges from your service provider. If you provided a cell phone number as your telephone number above, then you authorize us to call your cell phone (including text messages) using an auto-dialers, prerecorded messages, and text messages. These calls will provide account information and services, such as possible transaction approval, payment reminders, and collection efforts. If you do not want such auto-dialed calls, you can withdraw consent by notifying us in writing. If you do not want to receive such text messages about your account, you can withdraw consent by following the opt-out procedures in the message or notifying us in writing at Lifeline Lending, LLC 3855 North Ocoee Street, 5th Floor, Cleveland, TN 37312. *

Yes No

The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580, www.ftc.gov. * *