FIRST NAME:...........
LAST NAME:.......
ADDRESS:................
COUNTRY:..............
Phone number: .........
Fax number: ...........
OCCUPATION:...........
MONTHLY INCOME...........
AGE:...............
sex...........................
LOAN AMOUNT NEEDED:.......
Proposed Terms/Duration Of Loan:..................
Email:...................
OFFICE USE ONLy Verified by:______
Confirmed by: ___
LOAN AGENT 'S SIGNATURE:________
All replies should be forwarded to:aul...@gmail.com
Regards,
MR. AU.