Consumer Credit Application

Loan Information

Is this a Consumer or auto loan? Auto Loan Consumer Loan

Will this loan be secured or unsecured? Secured Unsecured

Proceeds of loan to be used for: Amount Requested

Are you applying as an individual or with a co-applicant? Individual Joint Credit Co-Signer

We intend to apply for joint credit: (initials)

Applicant Initials Joint Applicant Initials

Vehicle Loan Information

Auto Purchase Type

Vehicle New or Used New Used

Year Make Model VIN or Serial Number Mileage Insurance Company Insurance Company Phone Number

Applicant

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Driver's License Number State Issued Date of Issue Date of Expiration Current Residency Start Date Home Address City State Zip Code Previous Home Address City State Zip Code Previous Residency Start Date Home Phone Number Work Phone Number Cell Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted? Home Phone Work Phone Cell Phone

Name of nearest relative not living with you Address of nearest relative not living with you Relationship of nearest relative not living with you Phone Number of nearest relative not living with you

Housing Status

Housing Status Own Rent Other

Explain Residency Start Date

Applicant Employment

Applicant Employment Employed Not Employed

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Have you worked here for more than three years? (No if unemployed) Yes No

Previous Employer (if less than three years at current)

Employment Start Date Position or Title Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Income Information

Number of Dependents

Do you intend to rely on the co-applicant's earnings to qualify for this loan? Yes No

Other Monthly Income Income 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.

Is any income listed in this section likely to be reduced before the credit is paid off? No Yes

If Yes, explain

Have you previously received credit from us? No Yes

If Yes, when?

Co-Applicant

How would you prefer to be contacted? Home Phone Work Phone Cell Phone

Housing Status

Housing Status Own Rent Other

Explain Residency Start Date

Applicant Employment

Applicant Employment Employed Not Employed

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Have you worked here for more than three years? (No if unemployed) Yes No

Previous Employer (if less than three years at current)

Employment Start Date Position or Title Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Income Information

Number of Dependents Other Monthly Income Income 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.

Is any income listed in this section likely to be reduced before the credit is paid off? No Yes

If Yes, explain

Outstanding Debts

Housing

Not Applicable

Applies to: Name of Landlord or Mortgage Holder

Rent or Mortgage? Rent Mortgage

Name in which the account is carried Original Amount Present Balance Monthly Payments

Total Housing Payments

Automobiles

Not Applicable

Applies to: Name of Creditor Description of Automobile Account Number Name in which the account is carried Original Amount Present Balance Monthly Payments

Total Automobile Payments

Total of Outstanding Debt Payments

Total of Outstanding Debts (Housing + Auto Balances)

Total of Outstanding Debts

Net Worth (Total Assets - Total Debts)

Total Net Worth

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your Bank Name checking or savings account? Yes No

Account Number

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

Federal law provides important protections to members of the Armed Forces and their dependents relating to extensions of consumer credit. In general, the cost of consumer credit to a member of the Armed Forces and his or her dependent may not exceed an annual percentage rate of 36 percent. This rate must include, as applicable to the credit transaction or account: the costs associated with credit insurance premiums; fees for ancillary products sold in connection with the credit transaction; any application fee charged (other than certain application fees for specified credit transactions or accounts); and any participation fee charged (other than certain participation fees for a credit card account).

Are you or an immediate family member an active member in the Armed Forces? Yes No

Name of person serving If not you, what is your relationship to the active member

FEDERAL CREDIT APPLICATION INSURANCE DISCLOSURE

I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance product or annuity in connection with this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING THE EXTENSION OF CREDIT ON EITHER:

My purchase of an insurance product or annuity from you or from any of your affiliates; or
My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity.

By signing, I acknowledge that I have received a copy of this form on today's date. Unless this disclosure is provided electronically or I have applied for credit by mail, I also acknowledge that you have provided this disclosure to me orally.

Applicant's Signature Date

Joint-Applicant's Signature Date

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Bank Name 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 also authorize Bank Name to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date

Joint-Applicant's Signature Date

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