Finance Application

Applicant Information

Applicant Employer Information

Additional Information

Nearest Relative not living with you and not the Co-Applicant (if any)

Co-Applicant Information (if applicable)

Co-Applicant Employer Information

Additional Information

Nearest Relative not living with you and not the Applicant (if any)

Procedure Information

Terms and Conditions

All the information on this form is complete, correct and provided to Cogent Financial Group (Cogent) to obtain an installment loan or credit loan. I/we authorize Cogent to investigate credit and employment history and to report the credit experience of any party or authorized user to consumer reporting agencies and others. I/we understand that Cogent will retain this application whether or not it is approved. I/we understand that if the application is for a secured loan by real property that additional information is required. I/we certify that I am/we are 18 years or older and have completed the application questions accurately at any time after this application and/or during my/our relationship with Cogent. I/we authorize Cogent to obtain information concerning my/our employment and credit standing and authorize my/our employer, banks and/or other listed references to release information to Cogent. Cogent may review from time to time my/our eligibility for any credit extended on the account and may provide information about me/us to others. If I/we designate other authorized users, credit bureaus may receive account information on the authorized users in each users name. I/we agree to notify Cogent immediately upon any material change in the information I/we provided herein.

I/we affirm that each of the answers given to the foregoing questions is true and correct and that the foregoing is a true and correct statement of my/our financial condition. It is a federal criminal offense to knowingly make any false statement or report, or to willfully overvalue any property for the purpose of influencing Cogent to act on this application.

I/we understand and agree to the terms and conditions of this application