Prime Bank

Loan Information

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

Year

Make
     
       
(put n/a if not applicable)          
    VIN/SN Model Mileage
 
    (put n/a if not applicable)    

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 Prime Bank to verify information provided herein, including but not limited to employment and credit history.

 

 

 

Co-Applicant Information

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 Prime Bank to verify information provided herein, including but not limited to employment and credit history.