PremierBank - Consumer Loan Application

Loan Information

Amount Requested LoanTerm Which loan officer are you currently working with?

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. Completethe 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 (name below) 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. Joint Applicant Name Loan Purpose

To be secured by collateral?

Yes
No

If yes, describe collateral.

Describe Collateral Year Make Model Mileage VIN/SN

Personal Information

First Name Middle Initial Last Name Social Security Number Birth Date Marital Status Street Address City State Zip Code Telephone Number E-mail Address

Housing Information

Length of Residence Months / Years Housing Status Monthly Payment Mortgage Holder Estimated Property Value Mortgage Balance

Employment Information

Employer Telephone Number Supervisor Street Address City State Zip Code 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

Checking 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.

Do you need to fill out co-applicant information?

Yes
No

Co-Applicant Personal Information

Relationship to Applicant First Name Middle Initial Last Name Social Security Number Birth Date Marital Status Street Address City State Zip Code Telephone Number E-mail Address

Housing Information

Length of Residence Months / Years Housing Status Monthly Payment Mortgage Holder Estimated Property Value Mortgage Balance

Employment Information

Employer Telephone Number Supervisor Street Address City State Zip Code 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

Checking 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.