application – Affordable Repairs & Restorations

Fill out this form in a few easy steps to apply for financing.

Full Name (As per Legal Documents)

First Name

Last Name

Phone Number *

Do you want to save time by taking a picture or uploading:
1) Proof of Income (e.g. paystub), and
2) Proof of Residence (e.g. utility bill, mortgage statement)?

File Upload

Upload

Drop file here or click to upload

Maximum file size allowed: 250KB

Mailing Address

Address line 1 *

Address line 2

City *

State / Province *

Postal code / Zip Code *

Country *

Email *

Social Security Number (SSN) / Taxpayer Identification Number (TIN)

Employment Status

Gross Monthly Income

Monthly Mortgage or Rental Payment