HBLA COSIGNER INFORMATION FORM

The Hebrew Benevolent Loan Association’s goal is to loan money, interest free, to any Jewish person from Western New York in need of temporary financial assistance.

Thank you for your willingness to become a cosigner. Please provide the following information, which will be kept in the strictest confidence. We take every precaution to maintain the dignity and privacy of all borrowers and cosigners.

Borrower's Information
Amount of Loan Requested*
Please enter a number from 1 to 5000.
Borrower's Name*
First Last
Borrower's relationship to you*
How long have you known the applicant?*
Cosigner's Personal Information
Cosigner's Name*
First Last
Cosigner's Address*
Street Address Address Line 2 City State ZIP Code
Cosigner's Home Phone*
Cosigner's Cell Phone
Social Security Number*
I understand that I will be asked to provide my Social Security Number over the phone.
Cosigner's Driver's License Number*
I understand I will be asked to provide my Driver's License Number over the phone.
Cosigner's Email*
Enter Email Confirm Email
Do you rent or own your home?*
How long have you owned your home?*
Are you currently a cosigner on another HBLA loan?*
What is the amount of the loan?*
Cosigner's Employment Information
Place of Employment*
For how long?*
Business Address*
Street Address Address Line 2 City State ZIP Code
Business Phone*
Position/Title*
Annual Income*
Person who can verify your employment*
Consent*
I Consent
The Hebrew Benevolent Loan Association reserves the right to obtain credit reports on cosigners. By clicking the consent box, you are giving permission for the Hebrew Benevolent Loan Association to obtain your credit report. If the applicant's loan is approved, you as a cosigner must sign the Cosigner Repayment Form. You also acknowledge that you have received a copy of the HBLA Privacy Policy.
Signature*
Date*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

HBLA COSIGNER INFORMATION FORM

The Hebrew Benevolent Loan Association’s goal is to loan money, interest free, to any Jewish person from Western New York in need of temporary financial assistance.

Borrower's Information

Cosigner's Personal Information

Cosigner's Employment Information

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