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1. Customer Information (questions?)

Loan Amount:

Please select a loan amount

*First Name

Please provide your first name

*Last Name

Please provide your last name

*Street Address

Please provide your street address

Apt. or Suite #

*Zip Code

Please provide your zip code

Home Owner

Please select home owner option

Time At Address

Please select time at address option

Active Military

Please select active military option

2. Contact Information (questions?)

*Email Address

Please provide a valid email address

*Home Phone #

Please provide a valid phone number (valid format xxx-xxx-xxxx)

3. Employment Information (questions?)

Type of Income

Please select type of income option

Monthly Income

Please select monthly income option

*Employer Name

Please provide employer name

*Employer's Phone #

Please provide employer phone number (valid format xxx-xxx-xxxx)

Months Employed

Please select months employed option

Direct Deposit

Please select direct deposit option

Pay Frequency

Please select pay frequency option

*Upcoming Paydate (must be no later than 60 days)

Please select month

Please select day

Please select year

4. Bank Information (questions?)

Account Type

Please select account type

Don't have a checking account? Click Here!

*Bank Name

Please provide a bank name

Months With Bank

Please select months with bank option

*Bank ABA #

Please provide a valid bank routing number

*Bank Account #

Please provide a valid bank account number

5. Security Information (questions?)

*Date of Birth

Please select month of birth

Please select day of birth

Please select year of birth

*Driver's License #

Please provide a driver license

Driver's License State

Please select driver's license state

*Social Security #

Invalid social security number. (valid format XXX-XX-XXXX)

Credit Score

Please select estimated credit score

Credit card debt?

Please select credit card debt

We always have your security in mind. Rest easy knowing your data is protected with 256-bit encryption.

Upper Lake Lending is in no way affiliated with the Habematolel Pomo of Upper Lake, a federally recognized Indian tribe!

Upper Lake Lending

At Upper Lake Lending, we will match you with a loan program that meets your financial need and make funds available to you within 24 hours of application.

9620 Las Vegas Blvd S #Ste 570 Las Vegas, NV 89123

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844-546-4391

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