Consumer Loan Application

Loan Information

Purpose Amount Requested Loan Term
Detailed Description of Collector Car or Reason for Personal Loan
Year Make Model VIN/SN Mileage
(put n/a if not applicable)

Additional Loan Information
Dealer Purchase
Lease Buyout
Private Purchase
Type of Application
Individual credit
Joint credit with spouse
Joint credit with
who is not your spouse and must complete a separate application
Marital Status
Married (you may apply for separate or joint credit)
Separated
Unmarried (includes single, divorced, and widowed) List the number of people dependent on you for financial support:

Applicant Information
Name
Social Security Number
DOB
Driver's License
State
Street Address
City
Country
State
Zip
Time At Present Address
Yrs: Mos:
Home Phone
Cell Phone
Live with: Own
Rent
Parents
Other
Name & Phone of friend/relative not living with you
Previous Street Address(if less than 2 years current)
City
Country
State
Zip
Time At Present Address
Yrs: Mos:
Employer's Name
Address
City
Type of Business
Position/Title
E-mail
Work Phone
Time There
Yrs: Mos:
Gross Monthly Income
Do you intend to rely on spouse's earnings to qualify for this loan? Yes No Other Income
$ per month
Source
  If yes, your spouse also may be required to sign the promissory note Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.
Previous Employer (if less than 3 years at current)
Address
Phone
Position
Time There
Yrs: Mos:
Spouse Information (Complete even if spouse is not applying)
Name
Social Security Number
Date of Birth
Driver's License
State
Gross Monthly Income
Do you intend to rely on spouse's earnings to qualify for this loan? Yes No Other Income
$ per month
Source:
  If yes, your spouse also may be required to sign the promissory note Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.
Employer's Name
Address
City
Type of Business
Position/Title
E-mail
Work Phone
Time There
Yrs: Mos:
Previous Employer (if less than 3 years at current)
Address
Phone
Position
Time There
Yrs: Mos:
Bank References
Name
Branch/Address
Checking Acc't No.
Savings Acc't No.
Name
Branch/Address
Checking Acc't No.
Savings Acc't No.
Home Information
 Rent Own First Mortgage Holder or Landlord Address
Purchase Date/House
Purchase Price
Estimated Current Value
Balance Owing
Mortgage No.
Monthly Payment/Rent
Credit Reference (List all debts, including second mortgage).  Attach separate sheet if needed.
Name of Lender
Address
Account No.
Original Amount
Balance
Mo. Payment
 
Auto Loan (Open or Closed)
 
Have you or your Spouse ever:
Declared Bankruptcy?  Yes  No Had a Judgment?  Yes  No Had a repossession or foreclosure?  Yes  No
If yes, please Explain: 
 
Automatic Loan Payment
Do you want your monthly payment automatically deducted from your Kennebec Federal Savings checking or savings account?
Yes, Account #  No
Automatically transferred funds will be applied as my monthly payment on each monthly due date so long as there are adequate funds on deposit or there is available credit in my account, until the loan is paid or the Bank receives written notice to cancel. I understand the Bank reserves the right to terminate the automatic repayment plan without notice. Please initial your request. 
Agreement/Signature
I certify that all information provided by me is true, correct and complete. I authorize Kennebec Federal Savings to make whatever inquires about me you deem necessary and appropriate for the purposes of evaluating my credit application. including credit reports and contacting my employer. I also authorize Kennebec Federal Savings to provide credit information about its credit experience with me to other creditors and credit reporting agencies.

X:  X: 
Applicants Signature Date Spouses Signature. (Spouse should sign only
if applying for a joint credit)
Date