CREDIT APPLICATION

Fill out all required fields - indicated by a red asterisk.*
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$
Term of Loan*

SECTION 1: Application Information

Applicant Legal Name*
Date of Birth*
Please enter using the scroll arrows.
Years at this address?*
If less than 2 years, please fill out the previous address fields when they pop up.
Is your Mailing Address different from your Physical Address*
if yes, please fill out the Mailing Address fields when they pop up.


US Citizen*
Marital Status*
just enter a number or zero
just enter a number or zero
Housing*
Are you currently employed?*
Primary Income source:*
Do you have a secondary monthly income?*
If you do have a 2nd income, additional questions will pop up.
Please check the secondary income source:*
Do you have additional income to report?*
If you answer "yes," additional questions will pop up.
Alternate Contact (person not living with you):*

Demographics

Information is requested in accordance with the Equal Credit Opportunity Act and the requirements of regulatory agencies. It is voluntary and is not a factor in the loan decision.

Do you wish to answer the next 3 questions on gender, race and ethnicity?*
If you click “yes,” the 3 questions are required.
Race:*
Gender:*
Ethnicity:*

Co-Applicant Section

Do you wish to list a Co-Applicant?*
If you choose “Yes,” additional questions will pop up for the co-applicant.
Co-Applicant Legal Name*
Date of Birth*
Please enter using the scroll arrows.
Years at this address?*
If less than 2 years, please fill out the previous address fields when they pop up.
Is your Mailing Address different from your Physical Address?*
if yes, please fill out the Mailing Address fields when they pop up


US Citizen*
Marital Status*
just enter a number or zero
just enter a number or zero
Housing*
Are you currently employed?*
Primary income source:*
Do you have a secondary monthly income?
If you do have a 2nd income, additional questions will pop up.
Secondary source of Income?
Do you have additional income to report?*
If you answer "yes," one additional question will pop up.
- Copy

SECTION 2: Other Income Notice

Alimony, child support, or separate maintenance income need not be revealed if the applicant or co-applicant does not choose to have it considered for repaying this loan.

Do you receive income from alimony, child support or separate maintenance?*
If you answer YES, some additional questions will appear below.
If other income disclosed is for alimony, child support or separate maintenance, is such income pursuant to:*
How often received?

SECTION 3: Military Identification Statement

Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, please check one of the following statements: 
Note! Making a false statement in a credit application, including this statement, is a crime.

Questions for the Applicant:

I am a regular or reserve member of the Armed Forces serving on active duty.*
I am a dependent of a member of the Armed Forces because I am the member's spouse, the member's child, or an individual for whom the member has provided more than one-half of my financial support for 180 days immediately preceding today's date.*

Questions for
the Co-Applicant:

I am a regular or reserve member of the Armed Forces serving on active duty.*
I am a dependent of a member of the Armed Forces because I am the member's spouse, the member's child, or an individual for whom the member has provided more than one-half of my financial support for 180 days immediately preceding today's date.*

SECTION 4: Debts, Deposits & Investments

Outstanding Debts

Applicant

List Creditor, Balance and Payment.
We've provided 4 blanks for Creditors but that number is not required. Examples of creditors are: institutions you've borrowed money from, car loan companies, credit card companies, payday lenders, etc.

Co-Applicant

List Creditor, Balance and Payment.
We've provided 4 blanks for Creditors but that number is not required. Examples of creditors are: institutions you've borrowed money from, car loan companies, credit card companies, payday lenders, etc.

Bank and Investment Accounts

Applicant

List Financial Institution, Account Type, Balance
We've provided 4 blanks for Bank and Investment Accounts but that number is not required.
List all checking/savings accounts, certificates of deposit, retirement, and brokerage accounts.

Co-Applicant

List Financial Institution, Account Type, Balance
We've provided 4 blanks for Bank and Investment Accounts but that number is not required.
List all checking/savings accounts, certificates of deposit, retirement, and brokerage accounts.

Monthly Expense Worksheet

To qualify for a Fast Track approval, you must have a minimum credit score of 700 and debt to income ratio of 45% or less. If you know you do not meet this minimum requirement, you will need to complete the following monthly income and expense sheet. It may be helpful to have your bank statement, monthly bills, etc. to answer the following questions.

Have you had credit problems in the past?
(6 months ago or more)*
Have you had credit problems in the last 6 months?*

Section 1 Monthly Expenses

(Ignore any costs that don't apply to you). 

Monthly Bills

Applicant

Co-Applicant

Rent / House Payment
All utilities (electric, gas, water, trash)
Telephones (landline and cellphone)
Car expenses (fuel & maintenance)
Groceries & Household Expenses
Misc (clothes, haircuts, gifts, etc.)
Cablevision, Satellite TV/Internet
Eating Out
Other Entertainment (hobbies, cigarettes/ alcohol, gaming, etc.)
Insurance Cost
(car, health, home, life, etc.)
Medical Cost
(doctors, glasses, medications, dental)
Property Taxes
Home Repair
Credit Card Payment(s)
Rent to own cost
Child Support/Child Care/Alimony
Student Loans
Car Loan Payment
Other Loan Payment
Requested payment for THIS Loan?

Total Monthly Expenses

This row auto-totals the columns above.

Oklahoma Assistive Technology Foundation

APPLICATION CERTIFICATION and AUTHORIZATION

I am requesting that this application be accepted for review of a financial loan. I understand that the application includes my personal information, credit report, and Monthly Expense Sheet, and any additional information provided by BancFirst. I am stating that the Application is accurate and complete. I give Oklahoma Assistive Technology Foundation (OkAT) permission to verify the information provided in this application. I understand that any false or misleading statements are cause for denial, or removal of any approval made by OkAT. I understand that OkAT will keep this Application on file whether or not the loan request is approved. I agree to notify OkAT, in writing, of any change in name, address, phone number or employment. 

I understand that this is only a financial loan to purchase assistive technology and that OkAT nor banking partner (if applicable) does not provide any type warranty on the device or equipment purchased, and I can make no claims against either OkAT or any banking partner for any defects in the device or equipment, or any accident or injury resulting from its use. 

I understand that the loan cannot be used to refinance a previous purchase and cannot be used for general non-assistive technology maintenance, such as vehicle maintenance. 

For Approved Borrowers: 

All activity on the loan will be reported to the credit bureau. If your account becomes delinquent or behind in payment for more than 90 days, OkAT will determine next steps to satisfy outstanding loan balance, including: repossession, resale of device, external collections, and report the outcome to credit bureau agency. 

You understand that if your loan goes into fault, OkAT has the right to repossession and to take ownership of the equipment. Once ownership is taken, OkAT will make all attempts to resale the device for fair market value and use those funds to pay towards the balance owed. OkAT will also seek any and all legal means available for repayment of the amount owed on the account. 

Continuation of Certification and Authorization (page 2)

Release of Information for Required Data Collection Form

For Bank Guaranty Loans: 
If OkAT has guaranteed your loan for you with the banking partner, OkAT states that it will help you with up to three consecutive rescue payment on your behalf to keep your loan in good standing. You understand that if OkAT makes a payment on your behalf, you are obligated to repay that amount of money to OkAT. The applicant also understands that if the account is past due and repayment is deemed unlikely, OkAT will consider the loan a default, turn the loan over for external collections and seek all legal means available for repayment including repossession. You understand that if your loan defaults, OKAT will take possession and ownership of the equipment or device, attempt to resale the device for fair market value and use those funds to pay towards the balance owed. OkAT will seek any and all legal means available for repayment of the amount owed on the account. 

The loan you are applying for is provided through the Financial Loan Program with OkAT Foundation and Oklahoma ABLE Tech. The federal sponsor of this program is the Administration for Community Living of the U.S. Department of Health and Human Services. This federal program requires Oklahoma ABLE Tech submit end of year data. Information being collected does not include any names or other identifying information. It does include consumer (you) age, sex, geographic location, type of assistive technology purchased, details of loan terms, and overall satisfaction of the program. 

The federal sponsor also works with the Center for Assistive Technology Act Data Assistance (CATADA) to submit this information to a secure, web-based data system. All personally identifying information about you is removed, and summary results are then made available to the public at an accessible website. Again, all personal identifying information is removed before provided. 

As part of this data collection process, we would like to invite you to participate in a survey that provides the requested information mentioned above. We will send a written survey approximately 30 days after you have purchased your equipment. You have the right to decline to participate, but know that all responses will be kept confidential and you will not be identified by name in any database or in any reports. Your decision to participate or not in this evaluation process will not affect your loan application or participation in other programs. 

Release of Information: I consent to release this federally required information into the secure database. I understand that the information submitted will NOT contain my name, address, or any other identifying information. 

Continuation of Certification and Authorization (page 3)

808 South Main
Post Office Box One
Stillwater, OK  74076
Telephone (405) 742-6200
Fax (405) 742-6365

I request that BancFirst release my credit application and credit report information to the Oklahoma Assistive Technology Foundation (OkAT) and Oklahoma ABLE Tech. By releasing this information, I realize this information may be used in determining the outcome of my loan request.

Today's Date and Time is automatically entered below:*
:  

Note! If you click the "Submit" button and you DO NOT see a "Thank you" note, you may have inadvertently missed filling out a required field. This form should take you back to the page where that missing item is, you will need to scroll down the page, and the error will be highlighted in red. You can fill it out and move again to the this last page and "Submit" again.

If you continue to have trouble, use the "Save and Return Later" button below to keep all your data intact. BE SURE TO SAVE the password you're asked to create – we won't have it. Then, contact OkAT at staff@okatfoundation.org or 800.257.1705 and let us know you're having trouble. Thanks!

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