1. How much do you need ? (Loan Amount) Multiple of 50


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Form Fields


Form Fields
1.How much do you need ? (Loan Amount)

  • Multiple of 50

  • Range[100-5000]

  • maxlength - 5

  • accept digits only

2.What is this loan for ? (Loan Reason)



  • Debt Consolidation

  • Credit Card Consolidation

  • Home Improvement

  • Electronics/Furniture/Appliances

  • Major Purchase

  • Business Loan

  • Car Financing

  • Vacation

  • Wedding

  • Special Occasion

  • Student Loan Refinance

  • Green Loan

  • Medical Expenses

  • TAX

  • Others

3.What is your Email Address ? (Email)



  • Basic Email Structure validation

4. What is your Full Name & Last name (First & Last Name)



  • Should have 2 characters or more.

  • Last name should be different from FName

  • Maxlength = 20"

5. What is your Cell Phone Number ? (Phone Number)



  • Min =10

  • Max =10

  • Digits Only

  • Check first 3 digits for tollfree
    toll-free numbers typically start with the prefix "800," followed by "888," "877," "866," "855," or "844.

  • 1st and 4th digit not equal to 0 or 1

6.What is your Credit Score ? (Credit Score)



  • Excellent

  • Good Credit

  • Fair Credit

  • Bad Credit

  • Not Sure



7.Would you be interested in exploring debt consolidation options?If so, how much credit card debt do you currently have? (Debt Amount)

  • Options in YES & NO

If YES Then,
Debt Amount Input Field

  • Drop Down Selector

  • $0- $9,999

  • $10,000 - $19,999

  • $20,000 - $29,999

  • $30,000+

If No Then,
Debt Amount Field should be inactive
8. What is Your Street Address ? (Address)

  • It should have min 2 characters & 40 max

9. Are you a home owner ? (Home owner)



10. What is your driving licence? (Driving Licence)



11.Do you own a car that is fully paid off ? (Car)



  • YES or NO Option

12. Are you in military ?



  • YES or NO Option

13. What is your Date of Birth ? (DOB)



  • 18 years and above


14. What is your Income type ? (Income Type)

  • Employed or Benefits

If Employed:


15.1. What is your Employer’s Name ?

  • Min 2 & Max 40 Characters

If Benefits:
15.2. What is the name of source of income ?

  • Min 2 & Max 40 Characters

16. What is your Monthly Income ?
17. How Often you get paid ?

  • Monthly

  • Twice a month

  • Every 2 week

  • Weekly

18. When is your next Paydate ?

19. What is your Employer’s Phone ?



  • Min =10

  • Max =10

  • Digits Only

  • Check first 3 digits for toll free.
    toll-free numbers typically start with the prefix "800," followed by "888," "877," "866," "855," or "844.

20. Type of Bank Account ?



  • Checking & Saving Option

21. Do you get Direct Deposit’s ?



  • YES or NO Option

22. Deposit Details (Bank Account Details)


ABA Routing Number Field

  • Should be 9 digits

  • Check mod 10 (multiply the first digit by 3, the second by 7, the third by 1, the fourth by 3, the fifth by 7, the sixth by 1, etc., and add them all up.)

Bank Account Number Field

  • It should have Min=5 digits

  • Max=16

  • Digits only

23. SSN Number + reCAPTA CODE



  • Should be 9 digits

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