Index

Pre-Qualification Application

Name of Merchant or Doctor:

Service Provider Phone No

What is the purpose of your loan request?*

Purchase Price of Goods/Services?*

How would you rate your credit? *

Do you have any open collections?*

Have you declared bankruptcy in the last 5 years?*

First Name *

Middle Name

Last Name *

Social Security Number *

Date of Birth *

Area Code & Phone Number *

Email *

Home Address *

City *

State *

Zip Code *

Gross Monthly Income *

Authorization to run credit and fee notification:

By submitting your loan application, you hereby authorize Credit Technologies and/or our affiliated companies to run your credit and verify the information you listed on your application. You fully understand that Credit Technologies is a loan processing and technology company only. As such, we do not approve, deny or set the rate or terms on any loan approval. We also do not extend credit or make direct loans. The fee for our service is based on your loan amount and ability to qualify. Loan fees can range from $89 up to $789. Of the total fee, $89 must be paid after your request is pre-approved and before the final steps in processing your loan. The balance of any fee can be financed and is only due when your loan is funded. If you do not understand or agree with this policy, please do not submit this request. Otherwise, you are agreeing to these terms by clicking on submit below.

I Agree

Call us : (844) 995-4657