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Sample Data:
Applicant Information
 SS Number 
 First Name 
 Middle 
 Last Name 
 Mobile Phone 
 Home Phone 
 Email 
 Date Of Birth 
Address Information
 Street No 
 Pre Dir 
 Street Name 
 Street Type 
 Apt No 
 City 
 State 
 Zip Code 
 Move In Date 
 Residence 
 Mortgage/Rent 
Employment Information
 Type of Employment 
 Income Source 
 Other Source 
 Company Name 
 Start Date 
 Monthly Income 
 Other Income 
 Define Other Income 
 Work Phone 
Co-Applicant Information
 SS Number 
 First Name 
 Middle 
 Last Name 
 Mobile Phone 
 Home Phone 
 Email 
 Date Of Birth 
Co-Address Information
  Same address as applicant
 Street No 
 Pre Dir 
 Street Name 
 Street Type 
 Apt No 
 City 
 State 
 Zip Code 
 Move In Date 
 Residence 
 Mortgage/Rent 
Co-Employment Information
 Type of Employment 
 Income Source 
 Other Source 
 Company Name 
 Start Date 
 Monthly Income 
 Other Income 
 Define Other Income 
 Work Phone 
Loan Information
 Loan Amount Request 
  
Home Acceptance Corporation (the “Creditor”) is located at 1061 N. Kraemer Place, Suite G, Anaheim, CA 92806. All California Loans are made and/or arranged pursuant to Home Acceptance Corporation’s California Department of Financial Protection & Innovation Finance Lenders License #6030746.

I or we if there is a co-applicant (the “Applicant” or “I”) acknowledge that by clicking the box, “I Accept & Agree with the Authorization, Disclosures, Terms and Conditions and the Arbitration Provision” (contained in this website link), I am indicating my intent to sign this Credit Application and that this shall constitute my/our signature. I acknowledge that I have viewed, read and agreed with the “Authorization, Disclosures, Terms and Conditions and the Arbitration Provision” (contained in this website link) before signing this completed Credit Application; and, I have signed this completed Credit Application with one or more electronic signatures and my electronic signature has the same effect as my written ink signature. I agree and acknowledge that by providing my name, social security number or tax payer identification number, birth date and/or other Identifying Information in the Credit Application Information, I confirm my intent to apply for credit, to sign the Credit Application and to provide the authorizations given above and confirm the validity of my signature. The Creditor (including any assignee, transferee, or successor of the Creditor) may rely on this authorization as if I had personally signed this completed Credit Application.

By clicking on the box, “I (the “Applicant”) Accept & Agree with the Authorization, Disclosures, Terms and Conditions and the Arbitration Provision” (contained in this website link)

AGREEMENT TO ARBITRATE (If You Check the Box): You (the “Applicant”) agree and accept the Arbitration Provision (contained in this website link), the Applicant or We may elect to resolve any dispute by neutral, binding arbitration and not by a court action (except, for a small claims court action). See the Arbitration Provision for additional information concerning the agreement to arbitrate.

Pursuant to Section 22304.5 of the California Financial Code the following is a website link to a California Department of Business Oversight’s approved Credit Education Program. FDIC Money Smart for Adults: https://www.fdic.gov/consumers/consumer/moneysmart/adult.html.

The above referenced Credit Education Program is provided for general guidance and information. It is not intended as, nor should it be construed to be, legal, financial or other professional advice. Please consult with your attorney or financial advisor to discuss any legal or financial issues involved with credit decisions.

By clicking on the box. The Applicant hereby acknowledges receipt & access to the above referenced Credit Education Program website link.