First Name

Last Name

Phone *

Email *

Date of birth *

Street Address *

City *

State *

Country

Postal code *

Housing Status *

Rent

Mortgage

Other

Move in Date of Current Housing *

House Payment *

School, College or University Graduated *

Year Graduated *

Type of Income *

W2

1099/Business Owner

Proof of Income *

2024 w2 or 2024 schedule c

Mothers Maiden Name *

Social Security Number: *

Must give full social

Employer Address *

Employer Name: *

If self-employed, put your business information

Job Title: *

Industry *

Start Date *

Month/Year

Do You Own A Car *

No

Yes with Payments

Yes with No Payments

What Is Your Monthly Car Payment *

Put $0 if you do not have a car payment

HOW MUCH ARE YOU SEEKING? *

Signature *

Clear

By signing this form you are allowing Trifecta Credit Solutions LLC (Trifecta Funding) to process your application for funding. We will strategically apply you to our lending network to get you multiple offers for your consideration.

Please ensure that all your credit bureaus are unlocked. For personal term loans, our lenders do a soft pull, and for credit cards each application is a hard pull.