Auto/Personal Loan Application

Please select your preferred Citizens National Bank office  

Loan Information
Purpose *


 Amount Requested *
 Loan Term *
Detailed Description of Collector Car or Reason for Personal Loan
Year
 Make
 Model
 VIN/SN
 Mileage
(put n/a if not applicable)

Personal Information
First Name *
 MI
Last Name *
 Social Security Number *
Driver's License/State ID # *
 State of Issuance *
  
Street Address *
 City *
State *
 Zip Code *
 
Telephone Number *
 Birthdate (Month/Day/Year) *
 E-mail Address *

If residing at present address for less than two years, complete the following:
Own Rent     No Yrs.    
Former Street Address
 Former City
Former State
 Former Zip Code

Housing Information
Length of Residence *
 years  months
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 *
 years  months
Income *
 Per *
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Previous Employer
 Previous Telephone Number
 Previous Supervisor
Previous Street Address
 Previous City
Previous State
 Previous Zip Code
Previous Position/Department
 Previous Length of Employment
 years  months
Previous Income
 Per


Application to be completed *
Jointly (If Jointly Please Fill out Co-Applicant Information)
Not Jointly (Proceed to the next section)

Financial Information *

All fields are required as applicable.

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

Please note: Alimony, child support or separate maintenance income need not be revealed if the borrower (B) or co-Applicant (C) does not choose to have it considered for repaying this loan.  Also self employed borrowers may be required to provide additional documentation such as tax returns and financial statements. (before taxes)
Gross Monthly Income (Assets) * $ Other Income: (if any) $ Type

Current Monthly Housing Expenses
Rent: $
First Mortgage: $
Second Mortgage: $
Homeowners Insurance: $
Flood or Earthquake Insurance: $
Property Taxes: $
Mortgage Insurance: $
H. O. Assn Dues: $

List Checking & Savings Account Information Below *
Bank Name: *
Address: *
Account Number: * Account Value: * $
 
Bank Name:
Address:
Account Number: Account Value: $
 
Bank Name:
Address:
Account Number: Account Value: $

Stocks & Bonds (if applicable)
Description:
Value: $

Life Insurance (if applicable)
Face Amount: $
Cash Value: $

Real Estate Owned (if applicable)
Property Address:
City: State: Zip:
Estimated Value: $
 
Property Address:
City: State: Zip:
Estimated Value: $

Miscellaneous Assets
Fully Vested Retirement Funds: $
Net Worth of Business Owned: $
Home Sale Proceeds: $
Gift Funds: $
 
Automobile #1
Make/Model: Year: Value: $
Automobile #2
Make/Model: Year: Value: $
 
Other Asset: Value: $
Other Asset: Value: $

Current Monthly Payments (Liabilities) *

All fields are required as applicable.
Installment:
Name of Company: Payment: $
Name of Company: Payment: $
Credit Cards:
Name of Company: Payment: $
Name of Company: Payment: $
Name of Company: Payment: $
Name of Company: Payment: $
Other Mortgage Payments:
Name of Company: Payment: $
Name of Company: Payment: $
Alimony, Child Support, or Other Maintenance:
Name of Recipient(s) and months remaining: Payment: $
             

Information for Government Monitoring Purposes

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish that information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

Borrower
I do not wish to furnish this information
Ethnicity:
Race:
Sex:
 

Co-Applicant
I do not wish to furnish this information
Ethnicity:
Race:
Sex:

Acknowlegement

I/we have read the Privacy Notice.*
I/we authorize Citizens National Bank to review the credit history of all borrowers listed on the application. *
I/we have read the Electronic Records Consent and consent to the electronic delivery of required documents. The Electronic Records Consent will be sent to the email address entered in the borrower information section for authorization. *
I/we have read and consent to the Credit Insurance Disclosure. *

*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.

Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights commission administers compliance with this law. I certify that everything stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By Submitting below, I authorize the Citizens National Bank to verify any of the above information and to answer questions others may ask about my credit record with you. I understand additional information and documentation may be needed to complete this loan. I understand that I must update this credit information at your request and if my financial condition changes.

Submission of this form authorizes Citizens National Bank to verify information provided herein,
including but not limited to employment credit history.

 

Member FDIC, Equal Housing Lender