Consumer Loan Application


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 an 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.

 


Loan Information

What type of credit are you requesting?
*If you are applying for a joint account or an account that you and another person will use, complete all Sections, providing information about the joint applicant or user.
*Initial Here:
*What type of loan are you requesting?
Purpose of Loan:
*Description:
*Loan Amount: $
*Term of Loan:
 

This section is for Auto Loans only.
Purchase Price: $
* except for refinance
Year:
Make:
Model:
Vehicle Identification Number:
Mileage:
Name of Titleholders:
Existing Liens: $
Current Monthly Car Payment: $
Insurance Company Name:
Agent Name:
Agent Phone Number:
 

Applicant(s) Information

 

Applicant

Co-Applicant

 
*First Name:
Middle Initial:
*Last Name:
*Tax Payer ID Number (SSN/TIN):
*Date of Birth:
Current Address
*Street Address:
*City:
*State:
*Zip Code:
How Long:  Years  Months  Years  Months
*Monthly Rent or Mortgage Payment: $ $
*Phone Number:
*Email Address:
Previous Address (if less than 2 years at current)
Street Address:
City:
State:
Zip Code:
How Long:  Years  Months  Years  Months
Current Employer
Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Position:
How Long:  Years  Months  Years  Months
*Gross Income (before taxes) How Paid:
Hourly   $
      Hours per week    
Weekly   $
Monthly   $
Hourly   $
      Hours per week    
Weekly   $
Monthly   $
Average Monthly Overtime Pay: $ $
Previous Employer (if less than 2 years at current)
Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Position:
How Long:  Years  Months  Years  Months
Gross Income (before taxes) How Paid:
Hourly   $
      Hours per week    
Weekly   $
Monthly   $
Hourly   $
      Hours per week    
Weekly   $
Monthly   $
Driver's License/State ID Number:
Issue Date:
Exiration Date:
*Immigration Status - U.S. Citizen?
Other Income
Amount: $ $
Frequency:
Source:
 
Alimony, Child Support, Separate Maintenance Payments: You are not required to disclose income from alimony, child support, or separate maintenance payments. However, if you are relying on income from alimony, child support, or separate maintenance payments as a basis for repayment of this obligation, please complete the information below.
 
Payment Received Pursuant to:
Alimony per Month: $ $
Child Support per Month: $ $
Separate Maintenance Payments per Month: $ $
 
Marital Status: Do not complete if this application is for individual unsecured credit unless responding party resides in a community property state or is relying on property located in such state for repayment of the credit requested.
 
Marital Status:
Nearest Relative Not Living With You
Name:
Relationship:
Street Address:
City:
State:
Zip Code:
Phone Number:
 

Additional Information

If you, a joint applicant, or other party answers "yes" to any of the following questions, please explain in the space provided.
 

Applicant

Co-Applicant / Other Party

Are you a guarantor or co-maker of any leases, contracts, or debts?
Explain: 
Are there any suits or judgments pending against you?
Explain: 
Have you been declared bankrupt in the last 10 years?
Explain: 
 

Military Status

Federal law provides important protections to active duty members of Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to select one of the following statements as applicable and sign the selected statement:
 
I AM a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer.
 
I AM a dependent of a member of the Armed Forces on active duty as described above, because I am the member's spouse, the member's child under the age of eighteen yeard old, or I am an individual for whom the member provided more than one-half of my financial support for 180 days immediately preceding today's date.
 
I AM NOT a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer (or a dependent of such a member).
 
 
Warning: It is important to fill out this form accurately. Knowingly making a false statement on a credit application is a crime.
 

Information For Government Monitoring Purposes

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws . You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
 

Borrower

Co-Borrower

 
  I do not wish to furnish this information I do not wish to furnish this information
Ethnicity: Hispanic or Latino
Not Hispanic or Latino
Hispanic or Latino
Not Hispanic or Latino
Race: American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Sex: Male
Female
Male
Female
 

 

If you would like a copy of your application for your records, please before submitting.