PremierBank
Loan Information
Purpose Amount Requested Loan Term
   
APPLICANT(S)  Check one of the following boxes.  You may apply for separate credit in your name only, joint credit in your and the name of your spouse, or joint credit in your name and the name(s) of other joint applicant(s).  Note:  Separate credit and joint credit may also be marital purpose debt under Wisconsin Law.

Separate Credit.  Complete your personal information. Complete the co-applicants information about your spouse only if you are married and a Wisconsin resident.
Joint Credit with spouse as joint applicant.  Complete your personal information and the co-applicant information.
Joint Credit with as joint applicant who is not your spouse.  Each joint applicant must complete a separate application as if applying for separate credit.  Please also note this in the Additional Comments Section so we can put the two applications together.

Loan Purpose:
To be secured by collateral? Yes No     If yes, describe collateral:
Year Make   Model Mileage  
   
VIN/SN        
   
     

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

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

Other Debt Information

 
Type of Debt (Car Loan, Credit Cards) Balance Monthly Payment
 

Declarations
Are you obliged to make alimony, support or maintenance payments? Yes No
Are you a co-signer, endoser or guarantor on any loan or contract? Yes No
If so, for whom To whom
Are there any unsatisfied judgments against you? Yes No
Have you ever declared bankruptcy? Yes No
If yes, where (city, state) What year

Additional Comments:


* 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.

 

Notice to married applicant: No provision of a marital property agreement, a unilateral statement under Wis. Stat. sec 766.59 or a court decree under Wis. Stat. sec 766.70 adversely affects the interests of the bank unless prior to the time the credit is extended, the bank is furnished with a copy of the agreement statement or decree, or has actual knowledge of the adverse provision when the obligation to the bank is incurred.

 

Submission of this form authorizes PremierBank to 

verify information provided herein, including but not limited to employment 

and credit history.

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.

You will be required to come into one of our locations to complete the loan process. (Sign loan papers, verify information, etc.)

Privacy Policy Information

You must choose one of the following options:

I agree to accept PremierBank's Notice of Privacy Policy electronically.
I would like to receive PremierBank's Notice of Privacy Policy by mail.

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

 

 

 

 

 

 

eFinancial Bank
Personal Information

Relationship to Applicant 

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

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

Other Debt Information

 
Type of Debt (Car Loan, Credit Cards) Balance Monthly Payment
 


* 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 PremierBank to 

verify information provided herein, including but not limited to employment 

and credit history.