Request for Consumer Loan Application

Important Information About Procedures For Opening A New Account

(PATRIOT ACT)

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 you 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.

All applicants must have an account, product, or service with American State Bank in order to qualify for a consumer non-real estate loan.

Required Field

Loan Information

Are you applying as an individual or with a co-applicant?

Is this a personal or auto loan?

Vehicle Information

Applicant

Marital Status?

How would you prefer to be contacted?

Citizenship

Housing Status

Employment

Previous Employment (if less than 2 years)

Financial Information

Do you have a checking account?

Do you have a savings account?

Reference

Add Another Reference

Co-Applicant

Marital Status?

How would you prefer to be contacted?

Citizenship

Housing Status

Employment

Previous Employment (if less than 2 years)

Financial Information

Do you have a checking account?

Do you have a savings account?

Reference

Add Another Reference

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize American State Bank & Trust to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I agree to provide any further information the Bank might require to process my application.

We will contact you concerning your loan application and to provide you with disclosures required by the various laws and regulations.