Loan Application

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Please take a few moments to fill out this loan application. If your loan is approved we will call you to schedule an appointment. Usually this takes 1-2 business days, after you press the submit button. For personal service, please call Donna (773) 777-7600 ext. 1596. Nationwide Acceptance is only accepting Illinois applications. View our privacy policy before you start.
An asterisk(*) indicates a required field.
AMOUNT REQUIRED
* $
Purpose of Loan*
How did you hear about us?*
TELL US ABOUT YOURSELF
E-mail
First Name*
Middle name
Last name*
Social Security # * - -
Birth Date (mm/dd/yyyy)* / /
Current Address*
City*
State* Illinois residents only!
Zip*
Number of Years at Current Address* years / months
If less then two years at current address
Previous Address
City
State
Zip
Amount of Rent/
Mortgage Payment*		 $
Home Phone* (###) ###-####
Cell Phone (###) ###-####
TELL US ABOUT YOUR JOB
Current Employer*
Retired
Occupation*
Employer's Address*
City*
State*
Zip*
Work Phone* (###) ###-####
Number of Years and Months Employed There* years / months
Take Home Pay* $ Paid *
Previous employer (if less then two years with current employer)
Previous Employer
Occupation
Employer's Address
City
State
Zip
Work Phone (###) ###-####
Number of Years and Months employed there years / months
OTHER INCOME
(Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it as a basis for repaying this obligation. )
Other Income Amount
Source
TELL US ABOUT YOUR VEHICLE
Year
Make & Model
Paid For Owe
Monthly Payment $
Financed By
IMPORTANT NOTICE
The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age, income from a public assistance program, or having made a good faith complaint under the Consumer Credit Protection Act. If credit is denied, applicant is entitled to a statement of reason for such action from the creditor within 30 days. The federal agency which administers compliance with this law concerning this creditor is the Federal Trade Commission, Washington, D.C. 20580. Your Privacy is Important to Us. You May Obtain a copy of the Nationwide Privacy Policy by Calling Us at (800) 622-7605 We are permitted by law to share information about our transactions and experiences with you with other Nationwide Companies and any unaffiliated third parties, including consumer report and other creditors. In addition, we may share other information which we obtained from your application, consumer report and any unaffiliated third parties with other companies affiliated with Nationwide, unless you tell us not to share this information. If you do not want us to share information from your application, consumer report and any unaffiliated third parties with other companies affiliated with Nationwide, please notify us by calling us at (773) 777-7600 or writing to Nationwide, 3435 North Cicero Avenue, Chicago, IL 60641. Please include your name, address and social security number so that we can honor this request
You certify that the foregoing statements are true and complete and made for the purpose of determining your eligibility for credit. You agree that this application shall remain our property, whether or not accepted. We are authorized to make all inquiries we deem necessary to verify the accuracy of these statements made herein, and to determine your creditworthiness by procuring consumer reports from consumer reporting agencies and credit information from other financial ­institutions and extenders of credit, references, present and former employers, merchants, landlords and creditors. We are authorized to answer questions about your credit experience with us. We report all accounts to the credit bureaus. Please contact us if you feel there has been an error.
(Must be checked before application is submitted!)