GreenSky Installment Loan Application Information Form

GreenSky? Installment Loan Application Information Form

By submitting a loan application, you, the applicant, and co-applicant (if any) agree that you are applying for any product that any financial institution participating in the GreenSky? Program (a "Lender") may offer as part of the GreenSky? Program,

regardless of any product your merchant may have specifically discussed with you. The information from this form will be used to submit an application for a GreenSky? Program loan via the Program's computer application form.

Applicant Information

First Name*

Middle Initial

Last Name*

Requested Loan Amount (if known):

Date of Birth* (mm/dd/yyyy)

/

/

Social Security Number*

Home Phone*

Mobile Phone (See Disclosure)

Applicant Street Address*

(Physical address required. No P.O. Boxes)

Suite/Apt #

City*

State*

Zip Code*

Email Address

(If you provide an email address, GreenSky may use it to contact you about GreenSky? products, services, special offers and other promotions)

Employer

Years on the Job

Employer Phone Number

If Applicant is retired, enter "Retired" in the Employer field, enter "0" in the Years on Job field and enter the Applicant's home phone number. If Applicant is unemployed, enter "Unemployed" in the Employer field, enter "0" in the Years on Job field and enter the Applicant's home phone number.

Income

Alimony, child support or separate maintenance payments need not be revealed if you do not wish to have them considered as a basis for repaying the loan. Married Wisconsin Residents: Combine you and your spouse's information once.

Applicant's Gross YEARLY Income ($)*

Other Gross YEARLY Income ($)

Examples: yearly salary (before taxes) alimony, child support, investment income, social security, etc.

Examples: Co-Applicant and/or spousal income (before taxes), alimony, child support, investment income, social security, etc.

Co-Applicant Information

First Name*

Social Security Number*

Middle Initial

Last Name* Home Phone*

If completed below, Applicant and Co-Applicant intend to apply for joint credit.

Date of Birth* (mm/dd/yyyy)

/

/

Mobile Phone (See Disclosure)

Applicant Street Address* City*

(Physical address required. No P.O. Boxes)

Suite/Apt # State*

Zip Code*

Email Address

(If you provide an email address, GreenSky? may use it to contact you about GreenSky? products, services, special offers and other promotions)

Employer

Years on the Job

If Co-Applicant is retired, enter "Retired" in the Employer field, enter "0" in the Years on Job field and enter the Co-Applicant's home phone number. If Co-Applicant is unemployed, enter "Unemployed" in the Employer field, enter "0" in the Years on Job field and enter the Co-Applicant's home phone number.

Employer Phone Number

Married Wisconsin Residents

Applicant Spouse's First Name:*

Applicant Spouse's Street Address:*

City*

Co-Applicant Spouse's First Name:*

Co-Applicant Spouses Street Address:*

Sales Consultant

City*

Middle Initial Suite/Apt#* State* Middle Initial Suite/Apt#* State*

Applicant Spouses Last Name* Zip Code* Co-Applicant Spouse's Last Name* Zip Code*

Please see Disclosures and signatures continued on the next page

You may process the application at consumer

* Indicates that the field information must be included

Effective 02/11/2016

GSCP Installment Application Page 1 of 2

Effective February 11, 2016

TO BE COMPLETED BY SALES ASSOCIATE/ MERCHANT

Merchant Number

Applicant Type of ID

GSCP Installment Application Page 2 of 2

Plan Number [ ] Driver's License [ ] State/Province Issued ID [ ] Military ID [ ] Passport [ ] Tribal Card (please check one)

Applicant Name on ID

Co-Applicant Type of ID

State of Issuance ID Number

ID Expiration Date

[ ] Driver's License [ ] State/Province Issued ID [ ] Military ID [ ] Passport [ ] Tribal Card (please check one)

Co-Applicant Name on ID

Sales Associate/Merchant

State of Issuance ID Number

ID Expiration Date

Name

Phone Number

Email Address

You may process the application at consumer

Disclosures By submitting a loan application, you, the applicant, and co-applicant (if any) agree that you are applying for any product that any financial institution participating in the GreenSky? Program (a "Lender") may offer as part of the GreenSky? Program, regardless of any product your merchant may have specifically discussed with you.

THE FOLLOWING IS IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens a new account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

In addition, the following notices, disclosures, and authorizations apply to your application.

Alimony, child support, or separate maintenance payments need not be revealed if you do not wish to have them considered as a basis for repaying the loan.

By submitting an application for credit, you certify the following: (1) all of the statements (whether verbally or written) communicated to us, or to your merchant, are true and correct, and are made for the purposes of obtaining credit; and, (2) if more than one applicant is applying, each applicant intends to apply for joint credit and none is a co-signer (a "co-signer" is a person who agrees to be liable for the debt of another person without receiving the benefit of the loan, whereas a "joint applicant" is a person who intends to apply for joint credit and will receive the benefit of the loan; although we allow joint applicants to apply for joint credit, we do not allow borrowers to use "co-signers").

In addition, you authorize the GreenSky? Program, on behalf of the Lenders participating in the Program, to (1) obtain a credit report on you for any legal purpose in connection with this loan application, including any account update, extension of credit, or review or collection of your loan; and, (2) notify your merchant of our credit decision, and if approved, the credit decision and loan information, including, but not limited to, your approved credit limit, the repayment period for your loan, your approved APR, and account number. If you request, you will be informed whether a credit report was requested and, if so, the name and address of the consumer reporting agency that furnished this report. You also agree to provide additional financial information upon request.

By submitting a loan application, you expressly authorize the shared disclosure of loan related information, including but not limited to, your credit decision, proposed loan terms, and personal credit scores to any co-applicant, which will have the same effect as personal delivery to you. Also, if you provide an email address, we, and or the merchant, may use it to contact you about our products, services, special offers and other promotions.

Where applicable, you will be charged a one-time Account Activation Fee of $39 at the time of first purchase.

By providing your mobile number, you authorize us to contact you at that number using automated dialing technology or artificial or prerecorded voices for any purpose, including, but not limited to, to provide you with advertisements or telemarketing messages. You are not required to consent to this use as a condition of this loan application. You may revoke your consent at any time by contacting us at P.O. Box 24929, Atlanta, GA 30359.

Finally, upon loan approval, a Shopping Pass will be issued to you. Use of your Shopping Pass or your installment loan to make a purchase, whether in store, online, on the telephone, through your merchant, or otherwise by any borrower authorized on the loan agreement, will constitute acceptance of the loan and the loan agreement governing the Shopping Pass by all borrowers. The physical and electronic records of any such purchase will constitute the signature of all borrowers on the loan agreement.

NOTICES: California Residents: If you are married, you may apply for a separate account. Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law. Vermont Residents: We are engaged in loan production. Married Wisconsin Residents: If you are applying for individual credit or joint credit with someone other than your spouse, and your spouse also lives in Wisconsin, combine your financial information with your spouse's financial information. No provision of any marital property agreement, unilateral statement under Section 766.59 of the Wisconsin statutes or court order under section 766.70 adversely affects the interest of the lender, unless the lender, prior to the time credit is granted, is furnished a copy of the agreement, statement of decree or has actual knowledge of the adverse provision when the obligation to the lender is incurred. If married, you understand that your lender must inform your spouse if a credit account is opened for you.

Applicant Signature

XApplicant's Signature Co-Applicant Signature

XCo-Applicant's Signature

Date Date

Please provide a government issued picture ID to the Associate/Merchant.

If signed, Applicant and Co-Applicant intend to apply for joint credit.

Please provide a government issued picture ID to the Associate/Merchant.

Online: ? Email: service@ ? 855-707-4925

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