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GreenSky® Prequalification Request Form

A soft inquiry will be performed on your credit report, which won’t impact your credit score. Soft inquiries can only be seen by you. When you accept a loan offer and submit it for review, a hard inquiry will be performed, which may impact your credit score and can be viewed by third parties. To check your rate and view offers, please complete the application below.

By submitting this prequalification request, you are seeking prequalification for any product that we 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 a prequalification request to the GreenSky® Program via the Program’s online submission process.

Applicant Information

Amount Requested:

First Name

Last Name

Date of Birth (mm/dd/yyyy) (Min. Age 18. 19 in AL.)

Social Security Number

Mobile Phone

▢ By selecting this checkbox, you agree to the following: By providing your number, you agree that we, our agents, or our affiliates may use it to contact you about any product(s) or service(s) you obtain (or are obtaining) from us including using an automated dialing system, text message, or prerecorded messages, even if you may incur charges.

Street Address P.O Box not accepted.
ACP Program Participants:
call 833-815-6869 to apply.

City

State

Zip Code

Email Address

Email Disclosure: We may use this email address to send you information about your account and to contact you about our services, special offers and other promotions. You understand email is a not a secure means of communication and we are not responsible for any improper disclosure of the contents of an email properly addressed to you.

Gross Annual Income

Income Disclosure: List your total wages, retirement benefits and any income from investments or rental properties. Alimony, child support or separate maintenance is optional. If you include non-taxable income/benefits increase them by 25%.
Married Wisconsin Residents: Combine you and your spouse’s information once. Examples: yearly salary (before taxes) alimony, child support, investment income, social security.

Co-Applicant Information

First Name

Last Name

Date of Birth (mm/dd/yyyy) (Min. Age 18. 19 in AL.)

Social Security Number

Mobile Phone

▢ By selecting this checkbox, you agree to the following: By providing your number, you agree that we, our agents, or our affiliates may use it to contact you about any product(s) or service(s) you obtain (or are obtaining) from us including using an automated dialing system, text message, or prerecorded messages, even if you may incur charges.

Street Address P.O Box not accepted.
ACP Program Participants:
call 833-815-6869 to apply.

City

State

Zip Code

Email Address

Email Disclosure: We may use this email address to send you information about your account and to contact you about our services, special offers and other promotions. You understand email is a not a secure means of communication and we are not responsible for any improper disclosure of the contents of an email properly addressed to you.

Gross Annual Income

Income Disclosure: List your total wages, retirement benefits and any income from investments or rental properties. Alimony, child support or separate maintenance is optional. If you include non-taxable income/benefits increase them by 25%.
Married Wisconsin Residents: Combine you and your spouse’s information once. Examples: yearly salary (before taxes) alimony, child support, investment income, social security.

Required for Married Wisconsin Residents

Applicant Spouse’s First Name:

Middle Initial

Applicant Spouse’s Last Name:

Applicant Spouse’s Street Address:

City

State

Zip Code

Co-Applicant Spouse’s First Name:

Middle Initial

Co-Applicant Spouse’s Last Name:

Co-Applicant Spouse’s Street Address:

City 

State

Zip Code

TO BE COMPLETED BY SALES CONSULTANT/MERCHANT

Merchant Number

Requested Plan Number

Applicant Type of ID

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

Name on ID

State

ID Number

ID Expiration Date

Co-Applicant Type of ID

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

Name on ID

State

ID Number

ID Expiration Date

Sales Associate/Merchant Name and Contact Information

Disclosure Agreement

You, the applicant, agree and understand the following notice:

  • You have read, understand, and accept GreenSky’s Terms of Use at https://www.greensky.com/terms/website_terms_of_use, GreenSky’s Privacy Notice at https://www.greensky.com/privacy-policy, and GreenSky’s Consent to Electronic Records and Communication at https://www.greensky.com/information.
  • You are providing ‘written instructions’ to the GreenSky® Program under the Fair Credit Reporting Act authorizing the GreenSky® Program to obtain information from your personal credit profile or other information from Experian. You authorize the GreenSky® Program to obtain such information solely to conduct a pre-qualification for credit. You expressly authorize the GreenSky® Program to share with your Merchant and any manufacturer, including, respectively for each, any service providers, parent/affiliate entities, and franchisors/franchisees, the Prequalification decision, including the prequalified credit limit, loan terms, and prequalified APR.
  • When you check your rate and review loan offers, a soft inquiry will be performed on your credit report, which won’t impact your credit score. Soft inquiries can only be seen by you. When you accept a loan offer and submit your application for review, a hard inquiry will be performed, which may impact your credit score and can be viewed by third parties.

By signing below, you certify that the information is true and accurate.

Applicant Signature

x

Applicant's Signature

Date

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

Co-Applicant Signature

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

x

Co-Applicant's Signature

Date

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