IMDT Loan Application

Admission Representative:  

Applicant Information

First Name: Middle Initial:   Last Name:  

SSN: Phone #: Date of Birth:

Street Address:  

City:   State: AlabamaAlaska ArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana MaineMarylandMassachusettsMichiganMinnesotaMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington West VirginiaWisconsin Wyoming  Zip Code:  

Time at Address - Years:   Months:   Rents/Mortgage: $   Type: Rent OwnOther 

Email Address: Are you a US Citizen? YesNo 

License/ID Information

Photo ID#: Issuance State: AlabamaAlaska ArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana MaineMarylandMassachusettsMichiganMinnesotaMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington West VirginiaWisconsin Wyoming  Exp. Date:

Has your license ever been revoked? YesNo 

Employment Information

Current Employer:   Position:  

Time Employed -  Years: Months: Hourly Rate: $ Weekly Hours:  

Employer Phone Number:  

Other Income Sources

Spouse: $ Child Support: $ Other: $  

Bank Information

Bank Name: Routing #: Account #: 

Cosigner Information

First Name: Middle Initial: Last Name:  

SSN: Phone #: Relation: DOB:

Street Address:  

City: State:AlabamaAlaska ArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana MaineMarylandMassachusettsMichiganMinnesotaMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington West VirginiaWisconsin Wyoming Zip Code:  

E-Mail Address:  

Time at Address - Years:   Months:   Rents/Mortgage: $   Type: Rent OwnOther 

Cosigner Employer Information

Current Employer:   Position:  

Time Employed -  Years: Months: Hourly Rate: $ Weekly Hours:  

Employer Phone Number:  

Terms & Conditions of this Loan Application

Notice: You represent that all of the information you provided to IMDT in your Application is true and correct to the best of your knowledge, and may be relied upon by us. By completing the pre-qualification Loan application form you are giving IMDT written authorization to access your credit profile for pre-qualification purposes. I understand that IMDT will be acting as a loan-processing agent on my behalf and therefore does not set the rate and terms of my loan, approve or deny, discriminate against anyone for any reason or guarantee my loan approval. I understand that there may be additional fees and discounts associated with my loan approval and that I may be charged a loan processing fee if I elect to accept the terms of my loan. Furthermore, while calculated monthly, I understand that the total amount of the fees will be added to my base loan amount requested and become a part of my principal balance. I understand that IMDT is obligated to explain these fees to me before I sign additional loan documents. I agree to "hold harmless" IMDT from any and all legal actions that might be takes as a result of a disputed mater with my Service Provider or Vendor.

Merchant/Vendor: 1TopSchool - 2720 Old Rosebud Road, Suite 230 - Lexington, KY 40509 859.368.0575

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Document name: Loan Application

Unique Document ID: dd0076ed3a6d5b264dba6bdbb4f8f142a1dc5a11

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Timestamp	Audit
August 19, 2022 1:31 pm GMT	Loan Application Uploaded by Greg Goins - [email protected] IP 99.190.9.234
August 19, 2022 1:32 pm GMT	Loan Application - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
August 30, 2022 5:08 pm GMT	Loan Application - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
August 30, 2022 5:08 pm GMT	Loan Application - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
September 22, 2022 12:52 pm GMT	Loan Application - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
November 21, 2022 5:17 pm GMT	Loan Application - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234

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Audit Trail Serial# 429b6708aa46c8c68879a69cf092b72c