1-800-398-6657

City Loan Application Form

Please answer the following questions as completely as possible, so that we may better serve you.

Full Name:

Daytime Tel. Number:

Evening Tel. Number:

E-mail:

Is your vehicle paid off?

Is the title in your name?

CA Title:

Vehicle Year:

Vehicle Make:

Model & Trim:

(i.e. 2wd, 4wd, extended cab, XLT, LX, SE)

Odometer mileage:

Vehicle ID Number (VIN#):

(optional)

Loan amount requested:

Are you employed?

Are you a California resident?

How did you hear about us?

Verification Code:

Type the answer for above calculation that you see in the image: