Loan/Service Request

Thank you for your interest in Justine PETERSEN! Please complete a short form below to let us know how can we help:

Credit Building: Meet one-on-one with one of our credit building counselors to develop an action plan to improve your credit score and achieve your financial goals.

Housing: Meet one-on-one with one of our housing counselors to develop an action plan to achieve your housing goals, whether it's to purchase or refinance a home, discuss home repair options, access down payment assistance or prevent foreclosure.

Lending: Small Business Loan: New or existing JP clients can apply for a business loan and work with a counselor to achieve other credit goals. Small business loans range from $500-$150,000 and are for start-up or existing businesses. Most of our loans over $3k require collateral

Consumer Loan: New or existing JP clients can apply for a personal loan (up to $2500) and work with a counselor to consolidate debt, payoff high interest loans, or take other steps to build their credit.

Not sure that you want to apply for a loan right now? Select credit building to meet with a counselor who can talk to you about your specific situation and guide you through our process!

Please select the primary service requested

Housing Counseling

Housing Service Requested

Pre-Purchase HomeownershipForeclosure Prevention

Contact Information of Borrower

First Name

Last Name

Home Address

Street Address

City

State

Zip Code

Cell Number

000-000-0000

Home Number

000-000-0000

Preferred Number

CellHome

Personal Email

Work Email

Preferred Email

PersonalWork

Annual Income

Your Annual Income

Employer

Employment Start Date

MM/DD/YYYY

Additional Household Annual Income

Will there be a co-borrower?

YesNo

Contact Information of Co-Borrower

Co-Borrower First Name

Co-Borrower Last Name

Street Address

City

State

Zip Code

Cell Number

000-000-0000

Home Number

000-000-0000

Preferred Number

CellHome

Co-Borrower Personal Email

Co-Borrower Work Email

Preferred Email

PersonalWork

Amount Requested

Business Loan

Business Name

Business EIN

00-0000000

Business Type

Legal Structure

Drive

Have you made six on-time payments on your existing car loan (this is a program requirement)?

YesNo

Vehicle VIN#

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Mileage

Vehicle Body Style

Vehicle Trim Level

Vehicle Color

Approximate Remaining existing Car Loan Balance

Approximate Remaining number of payments on existing Car Loan

Current Interest Rate on existing Car Loan

Current Payment on existing Car Loan

Pre-Purchase Counseling Acknowledgements

Disclosure to Client for HUD Housing Counseling Services

Justine PETERSEN provides the following HUD-approved, one-on-one housing counseling services:

Pre-purchase counseling services;
Mortgage default counseling—foreclosure prevention services.

Counseling Descriptions:

Pre-purchase Counseling - Clients receive comprehensive one-on-one counseling, which covers the entire homebuying process from beginning to end. Counselors assist their clients with creating a sustainable budget/spending plan for their current household situation, and a clear action plan is developed to achieve the overall goal of homeownership. Clients also learn about credit building opportunities.

Mortgage default counseling - Clients receive assistance working with their lender to prevent foreclosure. Clients also learn about legal and financial resources to prevent foreclosure.

Relationships with Industry Partners:

Justine PETERSEN has financial or exclusive relationships, or both, with specific industry partners, such as Realtors, Insurance Agents, Home Inspectors and Real Estate Attorneys. Our agency also works directly with entities such as US Bank, Simmons Bank, Commerce Bank, US Mortgage, Busey Bank, Cadence Bank, Guild Mortgage and more

No Client Obligation:

There is no obligation to receive, purchase, or use any product or service offered by this agency, or any services of its industry partners, in exchange for receiving HUD housing counseling services.

Alternatives:

As a condition of our services, and in alignment with meeting our counseling goals, and in compliance with HUD’s Housing Counseling Program requirements, we may provide information on alternative services, programs, and products available to you, if applicable and known by our staff.

Signature - Please type your full name in acknowledgement of and agreement to the above Counseling Acknowledgements.

Form Agreement

By submitting this, I agree that the information included is truthful and accurate to the best of my knowledge. I understand that information and documents submitted via this online application are done so securely and the information is kept confidential. The information is used for the purpose of reviewing, evaluating, and underwriting the loan requested.*

By checking this box and typing my name below, I am electronically signing my Justine Petersen form.*

Signature - Please type your full name in acknowledgement of the above statements.

Credit Authorization

I give permission to Justine PETERSEN to obtain a copy of my credit report in order to work with me on improving my credit profile or to secure credit to build credit, purchase or improve a home, or capitalize a small business.

Notice of Furnishing Negative Information: I agree that Justine PETERSEN may make inquiries concerning your credit history and standing. If you are to receive a credit building, mortgage, or business loan through Justine PETERSEN and/or Great Rivers Community Capital we will report information concerning your performance under the loan agreement to the credit reporting agencies. Late payments, missed payments, or other defaults on your account may be reflected in your credit report. If you believe we have reported inaccurate information about your credit account to a credit bureau, notify us in writing as soon as possible.

Social Security Number

000-00-0000

Date of Birth

MM/DD/YYYY

Driver's License Number

Upload Photo of Government Issued ID

I authorizes Justine PETERSEN to obtain soft TransUnion credit reports, effective today, for follow up, research and tracking purposes. I understand that these credit reports do not affect my credit score.*

By checking this box and typing my name below, I am electronically signing my JP Credit Authorization.*

Signature - Please type your full name in acknowledgement of the above statements.