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Native 360 Pre-Application Form – Encryption Test

  • Credit Requested

  • I intend to apply for credit.
  • I/we intend to apply for joint credit.

  • Enter one item per line. Click the plus sign to add more lines.

  • Applicant Information

  • Complete the Applicant Information section for the first Applicant. Mark the appropriate box to indicate whether the Applicant is applying as a Borrower, Cosigner, Guarantor, Granter (of collateral), or Other for different capacity. If the Applicant is married, he or she may apply for individual credit.
  • Enter one per line. Click the plus sign to add more lines.
  • Enter one per line. Click the plus sign to add more lines.

  • Address Information

  • If rural, include Road and Box No.
  • If rural, include Road and Box No.

  • Employment Information

  • If self-employed, enter Name and Nature of Business
  • AmountPer
    Enter salary amount per period (week, month, year, etc.)
  • This field is hidden when viewing the form

    Second Employer (Hidden)

  • If self-employed, enter Name and Nature of Business
  • AmountPer
    Enter salary amount per period (week, month, year, etc.)

  • Applicant's Personal References

  • NameAddressPhoneRelationship 
    Please list three personal references. Click the plus icon to add another reference.

  • Co-Applicant Information

    1. If you are applying for joint credit or will be permitted to use the account, complete the Co-Applicant Information section as a Borrower.
    2. If the Applicant is applying for individual credit, but relying on income from alimony, child support, or separate maintenance or on. the income or assets of another person as the basis for repayment of the credit requested, complete the Co-Applicant Information section, to the extent possible, providing information about the person on whose alimony, support, or maintenance payments or income or assets the Applicant is relying.
    3. lf the Applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested, complete the Co-Applicant Information section with regard to the Applicant's spouse.
  • Enter one per line. Click the plus sign to add more lines.
  • Enter one per line. Click the plus sign to add more lines.

  • Co-Applicant Address Information

  • If rural, include Road and Box No.
  • If rural, include Road and Box No.

  • Co-Applicant Employment Information

  • If self-employed, enter Name and Nature of Business
  • AmountPer
    Enter salary amount per period (week, month, year, etc.)
  • This field is hidden when viewing the form

    Co-Applicant's Second Employer (Hidden)

  • If self-employed, enter Name and Nature of Business
  • AmountPer
    Enter salary amount per period (week, month, year, etc.)

  • Co-Applicant's Personal References

  • NameAddressPhoneRelationship 
    Please list three personal references. Click the plus icon to add another reference.

  • Questions

  • For Applicant

  • For Co-Applicant

  • Schedule of Other Income

    NOTICE: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

  • File Upload

  • Please upload PDF documents as directed by your loan officer, including pay stubs for the last two pay periods. We require personal tax returns for the last two years. If this is a loan for your business, we require the last two years of business taxes and personal taxes. If your loan is approved, we require a cancelled check to setup electronic loan payments from your checking account.
    Drop files here or
    Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, xls, xlsx, csv, pub, Max. file size: 512 MB.

    • Applicant Signature(s)

    • Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose.
    • I/We hereby apply for the loan or credit, as described in this application. I/We certify that I/We made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/We did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell any part of the loan. I/We further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit, or loan.
    • This field is for validation purposes and should be left unchanged.
    Save and Continue Later

    Native360 Loan Fund Inc. provides affordable credit, capital, technical assistance and related programs to help build strong and self-sufficient Native American business owners. We serve members of all tribes in our Nebraska, Iowa and southeast South Dakota service area.

    In accordance with federal laws and U.S. Department of the Treasury policy, this organization is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write to: U.S. Department of the Treasury, Director, Office of Civil Rights and Equal Employment Opportunity 1500 Pennsylvania Avenue, N.W., Washington, DC 20220; call (202) 622-1160; or send an e-mail to: crcomplaints@treasury.gov. To learn more about Native 360’s commitment to fairness and equity click here.

    Contact Us

    Physical Address:
    2550 N. Diers Ave.
    Suite K, Grand Island, NE 68803

    Mailing Address:
    P.O Box 5683, Grand Island, NE 68802

    Pete Upton, Executive Director

    Cell Phone – 308-850-0303
    Fax – 308-381-3668

    pete@native360.org

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