How Much Would You Like to Borrow? *
$200
$300
$500
$750
$1000
$1250
$1500
$1750
$2500
$5000
What Is This Loan For? *
Select
Major Purchase
Home Improvement
Credit Card Consolidation
Debt Payment
Furniture/Appliance/Electronics
Medical Expenses
Special Occasion
Vacation
Car Financing
Other
This helps lenders understand the purpose of your loan request.
Please select the option that best describes the reason for your loan.
How Much Debt Do You Have? *
Select
No Debt
Less than $10,000
$10,000-$12,500
$12,500-$15,000
$15,000-$20,000
$20,000-$30,000
$31,000-$50,000
$50,000+
Please enter the total amount of all outstanding debt.
Would You Like Us To Help With Your Debt? *
select
Yes
No
This will not affect your loan request.
What kind of home improvement?
Select
Windows
Roofing
Plumbing
Electrical
Bathroom
Kitchen
Gutters
Heating
Siding
Flooring
Home Security
Lawn Care
Mold
Painting
Pest Control
Water Damage
Air Conditioning
Other
Would you like us to help connect you
with a local service professional in your area?
Select
Yes
No
This will not affect your loan request.
What Is Your
Cell
Phone
Number?*
Why do we
require this?
Some lenders
prefer to
confirm your
request
by phone.
Clicking "NEXT"
is my
e-signature
authorizing
Breezy Financial to
share my
information with
lenders,
lending
partners,
lender-networks
and other
marketing
partners. In
certain cases,
contact may be
made via
SMS, Push and/or
Email messages.
What is Your
Date Of
Birth?*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
You must be at least 18 years old to qualify for a loan.
You must be at
old to qualify
for a loan.
Do You Own
Or Rent
Your Home?*
Select
Own
Rent
Other
How Many
Months Have
You Lived At
This
Residence?*
Select
Under 6
months
6-12
months
12-24
months
24-48
months
48-72
months
Over 72
months
Are You
Currently
Employed*
Select
Yes
No
Do You Serve
In The
Military?*
Select
No
Yes
What
Is Your
Monthly
Income?
*
Select
$0-$750
$750-$1,
500
$1,
500-$2,
500
$2,
500-$4,
000
$4,
000-$5,
500
$5,
500-$7,
000
$7,
000-$8,
5000
$8,
500-$10,
000
$10, 000
+
Total of all
sources of
income
before
taxes.
Please note
that you are
not required
to disclose
income that
is
alimony,
child
support, or
separate
maintenance
unless
you want to
use that
income
considered
as a basis
for
repaying
this loan.
How
Often Are
You
Paid?
*
Select
Bi-Weekly
Weekly
Twice a
Month
Monthly
Other
When Is
Your
Next
Payday?*
Month
January
February
March
April
May
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
Paydate must be a future date.
How
Long Have
You
Been
Employed?
*
Select
Less
than 3
months
3-12
months
1-3
Years
3-5
Years
10 +
years
What
Is
The
Name Of Your
Employer?*
We will not
contact your
employer. Please
enter your main
source of
income. Social
Security,
Disability and
Unemployment
income are OK.
What Is
Your
Work
Phone
Number?*
This number is
mandatory for
most banks.
Lenders will
never
call your
employer and
disclose that
they are from a
loan
company. If you
work for
yourself, please
use your cell
phone.
Is
Your
Paycheck
Received
via Direct
Deposit?*
Select
Yes
No
What
Is
Your
Primary Bank
Account?*
Select
Checking
Savings
Other
How
Long
Have You Had
This Bank
Account?*
Select
Less
than a
year
1-3
years
3-5
years
5-10
years
10-20
years
20 +
years
What
Is
Your
Credit
Score?*
Select
Excellent
Credit
(720-850)
Good
Credit
(690-719)
Fair
Credit
(630-689)
Poor
Credit
(330-629)
Not Sure
Would you like us to help figure out your credit
score?
Select
Yes
No
This will
not affect
your loan
request.
Would you like us to help you
repair your credit?
Select
Yes
No
This will
not affect
your loan
request.
Would you like us to help provide a credit
report?
Select
Yes
No
This will
not affect
your loan
request.
What
State
Was The
License
Issued?*
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgina
Washington
West Virgina
Wisconsin
Wyoming
What
Is Your
Social Security Number?*
Many lenders
need your Social
Security Number
to approve
your loan.
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site is
secured
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standard for
website and
information
security. If
you
would like to
learn more about
how our partners
may use your
information
for
credit
referencing,
please click
here .