Name
Date of Birth
SSN
Street Address
City
State
Zip Code
Home Phone# Own Home     Renting
Buying Home Other
Mortgage Payment or rent
Name & Address of Employer
Title/Position
Length of Employment
Business Phone #
# of Dependants
Name of Spouse
Date of Birth
Social Security Number
Name & Address of Employer
Title/Position
Length of Employment
Business Phone #
# of Dependants
If married, you may apply for a separate account.  If you are married, complete all information for yourself and your spouse.  You do not have to list spouse's separate property unless this is an application for a joint account.  Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.


List of Assets Amount List of Liabilities Amount Owed Monthly Payment
Cash in Gilmore Bank Income Taxes Payable
Cash in other institutions (list) Other Taxes Payable
  Charge Cards Payable (Schedule 4)
  Installment Loans (Schedule 5)
  Loans on Life Insurance
Stocks & Bonds Owned (Schedule1) Loans on Stocks & Bonds
IRA / Keogh / Pension Amounts  
Accounts / Notes Receivable (Schedule 2)  
Deeds of Trusts Owned (Schedule 2)  
Real Estate Market Value (s) (Schedule 3) Real Estate Indebtedness (Schedule 3)
Other Investments / Partnerships Other Liabilities (List)
Automobiles:  
  Total Payments
Personal Property Total Liabilities
Other Assets (attach detail) Net Worth (Assets-Liabilities)
Total Assets Total Liabilities + Net Worth
Annual Income Amount Annual Expenses Amount Contingent Liabilities Amount
Applicant Salary Interest Expense As an Endorser
Spouse's Salary Property Taxes As a Guarantor
Dividend / Bond Income Income & Other Taxes As a Co-signer
Interest Income Mortgage Payments/Rent On Damage Claims
Rental Income Credit Card Payments Letters of Credit
Other (Detail) Loan Payments Other (Detail)
  Insurance  
  Alimony, Child Support  
  Other (Detail)  
     

Total Income:

Total Expenses:

Total Liabilities:

GENERAL INFORMATION- If you are married, these questions apply to both you and your spouse.
Are any assets held  in Trust? Yes   No
Are any assets pledged or debts secured except as shown? Yes   No
Have you ever had a repossession? Yes   No
Have you ever had a bankruptcy or had a judgment against you? Yes   No
Have you ever been a principle or guarantor of a firm that declared bankruptcy? Yes   No
Are you a party to any claim or law suit? Yes   No
Has there been an IRS audit in the past 3 years? Yes   No
If yes, has the audit been settled? Yes   No
If yes to any of the above, please explain. Yes   No

Schedule 1: Marketable Securities:
Are any of your Securities Restricted? Yes No Do you own 10% or more of the outstanding stock of any company? Yes No
How Held # of Shares or Bond Amount Description Title In Name Of Pledged Present Market Value
  Indicate: [J] for jointly held with spouse     [O] for jointly held with other than spouse 
[A] for applicant's separate property  [S] spouse's separate property
Total $


Schedule 2: Notes Receivable - Mortgage & Deed of Trust Owned
How Held Name of Debtor Collateral Date of Note Monthly Payment Maturity Date Unpaid Balance
  Indicate: [J] for jointly held with spouse     [O] for jointly held with other than spouse 
[A] for applicant's separate property  [S] spouse's separate property
Total $
 

Schedule 3: Real Estate Holdings - Mortgages or Liens
Indicate Type:  [SD] for Single Dwelling  [MD] for Multiple Dwelling or  [C] for Commercial/Industrial
How Held Type Property Address a] Mrkt. Value
b] Orig. Cost
a] Date Punch
b] % Owned
Name of Lender a] 1st TD Bal.
b] 2nd TD Bal.
Monthly Payment







 






















































Indicate:  [J] for joint with spouse  [O] for joint with than spouse
[A] for applicant's separate property   [S] for spouse's separate property
Total Owed
Total Pmts


Schedule 4: Credit Cards And Loans Payable
Name of Creditor Monthly Payment Current Balance Name of Creditor Monthly Payment Current Balance

Totals

$ $

Totals

$ $


I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Gilmore Bank to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Gilmore Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of Section 1808.21 of the California Vehicle Code. I agree to provide any further information the Bank might require to process my application.


Applicant's Signature

Date

Spouse's Signature
(only if applying for joint credit)

Date
 
   
 
Member FDIC. Equal Housing Lender.