Apply For A Revolving Loan
(Minimum $25 - Maximum $350)
Pay Back Weekly
Maximum 16 Weeks Payment Plan
Recommended Weekly Payment $25
Loan Used for Sober Living Move-In Fee Only
Name:
Client first name Client last name
Phone Number:
Client phone
Email:
Client email
Date Of Revolving Loan Application:
Date
Date Of Birth:
Client birthdate
Clean/Sober/Recovery Date:
Date
Amount Requested:
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How Could A Housing Loan Benefit Your Recovery?:
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Have You Been Accepted To A House?
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If Accepted, House Name And Address
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House Manager/President Name:
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House Manager/President Phone Number:
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House Manager/President Email:
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If the revolving loan is approved, I agree to begin paying this loan after a term of (30 Days) from receipt of the funds and not to exceed a period of 12 weeks.
Applicant Initials:
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Applicant Signature:
Signature
I acknowledge and understand that to qualify for Recover Revolution's Revolving Loan Program, the following steps must be completed upon submission of the Revolving Loan application:
- I will contact Jacqui as soon as possible via email at jacqui@recoverrevolutionnj.org or by text at 848-373-5829.
- It is my responsibility to notify my House President/House Manager to contact Jacqui once I have successfully moved in and completed a clean drug test.
- It is the House President/House Manager’s responsibility to reach out to Jacqui via email or text in order for the Revolving Loan to be approved.
Do you Agree To These Terms:
Checkboxes
By adding my signature, I am fully aware that if I do not follow this process, my Revolving Loan application may not be approved.
Signature
By continuing, you agree that your electronic signature is the legally binding equivalent to your handwritten signature. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You will not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.