Overdraft Protection and Auto Loan Application

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Loan Information

Auto ( or other vehicle) Loan Other Loan Request $ for months
Dealer Purchase Lease Buyout Private Purchase Refinance New Used Year/Make/Model
Insurance Agent Name + Company Insurance Agency Phone
Other Collateral details

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 Referred by:

Name Social Security Number DOB
Driver's License State and Date Issue
Street Address City Country State Zip Time At Present Address Yrs: Mos:
Home Phone Cell Phone Live with: Own Parents Rent 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

If yes, your spouse 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:

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

If yes, your spouse 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). 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 or Collection item? 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 eFinancial Bank 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 eFinancial 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 eFinancial Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies.

Applicants Signature Date Spouses Signature.

(Spouse should sign only if applying for a joint credit)

Date