Secure Online Application

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Loan Details

CONTRACTOR Company Name*

Not already working with a contractor? Contact ELN for a list of contractors that service your area! info@energyloannetwork.com (844) 356-5626 option 2

Name of the SALES AGENT

Email of the SALES AGENT

Requested Amount* $

Requested amount should include the entire loan amount, including any combo-loan portion.

Plan Number*

Don't have a Plan Number? Contact your contractor for Plan Number information.

Type of Project*

Solar Roofing Battery Storage HVAC (Heating, Ventilation, Air Conditioning) Windows Other Project Types

Select one or more options above.

Other Project Type Description

Include Joint Applicant?

Yes

Joint Applicant assumes equal liability for the obligation and benefits from the proceeds of the obligation.

Applicant Personal Information

First Name*

Please use Full Legal Name as shown on DL/ID

Middle Name

Last Name*

Social Security Number*

Enter as 000-00-0000

Date of Birth*

Marital Status

Applicant Property Address

Address*

City*

State*

Zip Code*

County*

Occupancy Status*

FINANCING IS NOT AVAILABLE FOR HOMES WITH A REVERSE MORTGAGE. PLEASE CONTACT YOUR CONTRACTOR.

Time at Residence (years)*

Time at Residence (months)

Time at Residence (in years)

Mortgage Payment*

Housing Pymt

Applicant Contact Information

Home Phone*

Please enter a mobile number if you do not have a home phone number. By submitting your cell phone number, you hereby provide your express consent to receive SMS messages from us. You understand and agree that these messages may be sent using an automated system and may include updates, requests for information to assist in processing a loan, and other relevant information. You may opt-out of receiving SMS messages at any time. Message and data rates may apply. Please consult your mobile carrier for more information.

Cell Phone

By submitting your cell phone number, you hereby provide your express consent to receive SMS messages from us. You understand and agree that these messages may be sent using an automated system and may include updates, requests for information to assist in processing a loan, and other relevant information. You may opt-out of receiving SMS messages at any time. Message and data rates may apply. Please consult your mobile carrier for more information.

Work Phone

Work Extension

Email*

Applicant Employment

Employment Status*

Source of Income*

**BE SPECIFIC!** Example: Pension from Teacher Retirement

Employer*

**BE SPECIFIC!** List name of company even if Self Employed

Position*

**BE SPECIFIC!** Example: Retired Teacher, Car Sales, CEO Security Company...etc.

Start Date*

Gross Monthly Income* $

Applicant Other Income

Statement of other income – Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as basis for repaying this obligation.

Other Source of Income 1

Monthly Amount 1 $

Other Source of Income 2

Monthly Amount 2 $

Joint Applicant Information

How are you related to the Primary Applicant?*

Joint First Name*

Please use Full Legal Name as shown on DL/ID

Joint Middle Name

Joint Last Name*

Joint Social Security Number*

Enter As 000-00-0000

Joint Date of Birth*

Joint Marital Status

Joint Applicant Address

Joint Address*

Joint City*

Joint State*

Joint Zip Code*

Joint Occupancy Status*

Joint Time at Residence (years)*

Joint Time at Residence (months)

Joint Time at Residence (in Years)

Joint Mortgage Payment $

Joint Housing Pymt $

Joint Applicant Contact Information

Joint Home Phone*

Joint Cell Phone

Joint Work Phone

Joint Work Extension

Joint Email

Joint Applicant Employment

Joint Employment Status*

Joint Source of Income*

Joint Employer*

Joint Position*

Joint Start Date*

Joint Gross Monthly Income*

Joint Applicant Other Income

Statement of other income – Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as basis for repaying this obligation.

Joint Source of Other Income 1

Joint Monthly Amount 1 $

Joint Source of Other Income 2

Joint Monthly Amount 2 $

Application Disclosures

The applicant (and co-applicant) hereby confirm the following: (1) Applicant(s) have read and agree to the terms of our Privacy Notice and Terms of Use; (2) all information provided in this application is true, accurate and complete; (3) the Energy Loan Network is authorized to forward this application to its participating lender(s); (4) The participating lender(s) may retrieve the applicant(s)’ credit report; and (5) the Energy Loan Network may share information on the status of this application with the associated contractor.

If you confirm the above disclosure, select "YES":*

Joint Intent

We intend to apply for joint credit.

Who will initial the declaration?*

Applicant Only Joint Applicant Only Both Applicants

Applicant Initials*

Joint Applicant Initials*

Do you belong to a Credit Union? (Optional)

Name of Credit Union (Optional)

Comments

Date/Time*

ApplicationSource*