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Consumer Loan Application

Loan Information

Type of Application

Marital Status

Auto Loan Personal Loan
Loan Request Amount
$ for months
Dealer Purchase Lease Buyout
Private Purchase Refinance
 
New Used
 
Year
Insurance Co.
Phone
Individual credit
Joint credit with co-applicant
Joint credit with

who is not your co-applicant and must
complete a separate application.
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

Referred By
Name
Social Security Number
DOB
Driver's License
State
Home Phone
Cell Phone
Live with: Own
Rent
Parents
Other
Name & Phone of friend/relative not living with you
Street Address
City
Country
State
Zip
Time At Present Address
Yrs: Mos:
Previous Street Address (if less than 2 years current)
City
Country
State
Zip
Time At Previous Address
Yrs: Mos:
Employer's Name
Address
City
Type of Business
Position/Title
Work E-mail
Work Phone
Time There
Yrs: Mos:
Gross Monthly Income
Do you intend to rely on co-applicant's
earnings to qualify for this loan?
Yes  No
If yes, your co-applicant also may be required to sign the promissory note
Other Income
$per month
Source
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:

Co-applicant Information (Complete even if co-applicant is not applying)

Name
Social Security Number
Date of Birth
Driver's License
State
Gross Monthly Income
Do you intend to rely on co-applicant's
earnings to qualify for this loan?
Yes  No
If yes, your co-applicant also may be required to sign the promissory note
Other Income
$per month
Source
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. Provide additional documentation if needed.
Name of Lender
Address
Account No.
Original Amount
Balance
Mo. Payment

 

Detailed Description of Collateral and Purpose of Loan

Have you or your co-applicant ever:
Declared Bankruptcy? Yes No
Had a Judgment? Yes No
Had a repossession or foreclosure? Yes No
If yes to any of the above, please explain below

Automatic Loan Payment
Do you want your monthly payment automatically deducted from your 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 the bank 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 the bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies.
X: X:
  Applicant Signature Date Co-applicant Signature
(Co-applicant should sign only if applying for joint credit)
Date