HBLA Personal Loan Application

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.

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Eligibility Verification

To qualify for an HBLA loan, borrowers must be Jewish and a resident of one of the following eight counties in Western New York: Erie, Niagara, Genesee, Allegany, Cattaraugus, Chautauqua, Wyoming and Orleans.

Are you Jewish and reside in Western New York?*

Yes

You are not eligible to receive an HBLA loan.

Applicant's Personal Information

Amount of Loan Requested*

Please enter a number from 1 to 5000.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

Email*

Enter Email Confirm Email

Alternate Email Address

Date of Birth*

Place of Birth*

Driver’s License Number*

Issuing State*

Do you currently Rent or Own your home?*

How long have you owned your home?*

Are you a US Citizen?*

How long have you been a Western New York Resident?*

Marital Status*

Name of Spouse

Number of Current Dependents

Co-Signer Information

Please send your co-signer the application to fill out. The link is https://jewishphilanthropies.org/hbla-cosigner-information-form/.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

Email*

Enter Email Confirm Email

Employment Information

Are You Currently Employed?*

Date Hired*

Name of Employer

Work Phone

Work Address

Street Address Address Line 2 City State ZIP Code

Your Job Title

Immediate Previous Employer

Additional Information

Purpose of Loan*

Have you received a loan from the HBLA previously?*

Loan Amount*

When*

How did you hear about the HBLA?*

Other relevant information about yourself you think we should know

Financial Worksheet

This is intended to help you gather financial information for when you meet with the Loan Committee to review your application. Please complete this fully (showing MONTHLY figures) to the best of your ability.

Average Monthly Income

Applicant's Monthly Take-Home Salary*

Spouse's Monthly Take-Home Salary

Child Support

Alimony

Financial Assistance from Family

Other Source(s) of Income

e.g. real estate income, social security, etc.

Other Source(s) of income

TOTAL MONTHLY HOUSEHOLD INCOME*

Average Monthly Expenses

Monthly rent/mortgage*

Utilities*

(gas, electric, water, etc.)

Utilities*

(gas, electric, water, etc.)

Phone/Computer/Internet

Car Expenses

(insurance, gas, repair)

Child(ren) expenses

(day care, child care, tuition)

Child Support/Alimony

Medical/Health Insurance

Food

Credit Card Payment(s)

Loan Payment - Car

Loan Payment - Home Improvement

Loan Payment - Tuition

Other Expenses

TOTAL MONTHLY HOUSEHOLD EXPENSES*

Additional financial information or special circumstances you think we should know:

Uploads (submitted as PDF or JPG)

Proof of income—most recent pay stub(s)
Government issued photo ID (ex: Driver’s License)
Most recent Federal income tax return

Proof of income — most recent pay stub(s)*

Max. file size: 50 MB.

Government issued photo ID (ex: Driver’s License)*

Max. file size: 50 MB.

Most recent Federal income tax return*

Max. file size: 50 MB.

Your Tax Return Transcript or Summary sheet is not sufficient, please submit your most recent FULL Federal tax return.

Consent

Applicant's Signature*

Date*

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HBLA Personal Loan Application

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.

Eligibility Verification

Applicant's Personal Information

Co-Signer Information

Employment Information

Additional Information

Financial Worksheet

Average Monthly Income

Average Monthly Expenses

Uploads (submitted as PDF or JPG)

Consent

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