Updated logo for all submissions

USA Patriot Act
IMPORTANT INFORMATION ABOUT OPENING AN ACCOUNT

On September 11, 2001, our lives changed forever. In an effort to protect you and our country, the USA PATRIOT Act was signed into law. 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.

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 ask to see your driver’s license or other identifying documents.

We proudly support all efforts to protect and maintain the security of our customers and our country.

 


Loan Information
Purpose Amount Requested Loan Term
       
Detailed Description of Collector Car or Reason for Personal Loan

Minimum Loan amount is $1000.00
Year Make        
       
(put n/a if not applicable) VIN/SN        
  Model Mileage
(put n/a if not applicable)

I intend to apply for: individual credit joint credit

Personal Information
First Name
MI
Last Name Social Security Number
Street Address City State Zipcode
Telephone Number Birthdate (Month/Day/Year) E-mail Address

Housing Information
Length of Residence Housing Status Monthly Payment
Mortgage Holder Estimated Property Value Mortgage Balance

Employment Information
Employer Telephone Number Supervisor
Street Address City State Zipcode
Position/Department Length of Employment Income Per

Financial Information
Do you have a Checking Account? Yes No
Checking Account Number Financial Institution
Do you have a Savings Account? Yes No
Savings Account Number Financial Institution

References
Name of a Relative Relationship to Applicant Telephone Number
Street Address City State Zipcode
Name of a Personal Friend Address (Street, City, State, Zip) Telephone Number

CLICK HERE to access the Co-Applicant section or Click "Submit" below to finish!

* Please Note: Alimony, child support, or maintenance income need not be revealed 

if you do not wish it to be considered as a basis for repaying this obligation.

 

Submission of this form authorizes FNBC to 

verify information provided herein, including but not limited to employment 

and credit history.

 

Before submitting, you must accept the disclosure at the end of the page.

Updated logo for all submissions

I intend to apply for: individual credit joint credit

Personal Information

Relationship to Applicant 

First Name
MI
Last Name Social Security Number
Street Address City State Zipcode
Telephone Number Birthdate (Month/Day/Year) E-mail Address

Housing Information
Length of Residence Housing Status Monthly Payment
Mortgage Holder Estimated Property Value Mortgage Balance

Employment Information
Employer Telephone Number Supervisor
Street Address City State Zipcode
Position/Department Length of Employment Income Per

Financial Information
Do you have a Checking Account? Yes No
Checking Account Number Financial Institution
Do you have a Savings Account? Yes No
Savings Account Number Financial Institution

References
Name of a Relative Relationship to Applicant Telephone Number
Street Address City State Zipcode
Name of a Personal Friend Address (Street, City, State, Zip) Telephone Number

* Please Note: Alimony, child support, or maintenance income need not be revealed if you
do not wish it to be considered as a basis for repaying this obligation.

 

Submission of this form authorizes FNBC to verify information provided herein, including
but not limited to employment and credit history.

 

Purpose

You have submitted an application for a loan. In connection with your loan application, Lender may be soliciting, offering to sell, or will sell you an insurance product or annuity. Federal law requires Lender to provide you with the following disclosures.

Credit Disclosure

1. Lender, as a condition of granting you a loan, cannot require that you purchase an insurance product or annuity from Lender or any of its affiliates.
2. Lender, as a condition of granting you a loan,cannot require your agreement not to obtain or prohibit you from obtaining an insurance product or annuity from an unaffiliated entity.

Acknowledgment

BY SIGNING BELOW, I ACKNOWLEDEGE THAT I HAVE READ, RECEIVED AND UNDERSTAND THIS INSURANCE DISCLOSURE.

I accept the above disclosure