Borrower * First Name: Middle Name: Last Name: Phone Number: * PRIMARY - ALTERNATE -     ALTERNATE - Email Address: Current Address: City: State: Zip: Co-Borrower First Name: Middle Name: Last Name: Phone Number: PRIMARY - ALTERNATE -     ALTERNATE - Email Address: Current Address: City: State: Zip: Social Security #: Date of Birth:     Social Security #:     Date of Birth:

Loan Amount:    
Term Requested:

Comments/Any additional information to describe your financing needs

Forwarded my request to:  General Request Raja Paleja Kelly Guldi Rodney Arzouni Erin Barnett

By checking the box below and submitting this form, I/we hereby authorize Maharaja Financial Services, Corp and or assigns (hereafter MFSC) to verify my past and present employment earnings records, bank accounts, stock holdings, and any other asset balances that are needed to pre-qualify me/us for financing. I further authorize MFSC to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. It is understood that by clicking “submit” below, this electronic submission of this form serves as my/our authorization. The information MFSC obtains is only to be used in the pre-qualification of me/us for financing.

“I/we agree to the above authorization”