Financing Application APPLICANT INFORMATION Requested Loan Amount If Known Finance PlansFinance Plans12 Months Same as Cash60 Months - Low APR120 Months - Low APRShieldRoof does not qualify for our 120 month program. First Name Middle Name Last Name Date of Birth Social Security # Email Address Mobile Phone Home Phone Applicant AddressStreet Address City State / Province / Region ZIP / Postal CodePhysical Address Required. No P.O. Boxes. Please Check What Applies To You:Are you interested in our DefenderRoof?Are you interested in our ShieldRoof?Are you currently working with one of our roof consultants?Are you interested in our SuperRoof? How do you rate your credit?ExcellentGoodFairPoor Employer Years on the Job Employer PhoneIf Applicant is retired, enter "Retired" in the Employer field, enter "0" in the Years on Job field, and use the Co-Applicant's Home phone number.If Applicant is unemployed, enter "Unemployed" in the Employer field, enter "0" in the Years on job field, and use the Co-Applicant's home phone number.INCOME Applicant's Gross MONTHLY Income ($)Examples: Monthly salary (before taxes), alimony, child support, investment income, social security, etc. Other Gross MONTHLY Income ($)Examples: Co-Applicant and/or spousal income (before taxes), alimony, child support, investment income, social security, etc.CO-APPLICANT INFORMATION Add a Co-Applicant?Add a Co-Applicant?NoYes First Name Middle Name Last Name Date of Birth Social Security # Email Mobile Phone Home Phone Employer Years on the Job Employer PhoneIf Applicant is retired, enter "Retired" in the Employer field, enter "0" in the Years on Job field, and use the Co-Applicant's Home phone number.If Applicant is unemployed, enter "Unemployed" in the Employer field, enter "0" in the Years on job field, and use the Co-Applicant's home phone number.APPLICANT SIGNATURE Applicant SignatureBy typing your name, you certify that the facts stated above are true and correct to the best of your knowledge and that you authorize a credit inquiry by Hippo Roofing. DateCO-APPLICANT SIGNATURE Co-Applicant SignatureBy typing your name, you certify that the facts stated above are true and correct to the best of your knowledge and that you authorize a credit inquiry by Hippo Roofing. Date