Loan Application

Applications sent outside of regularly scheduled hours, on weekends or on holidays in which Dakota Western Bank is not open, are considered received on the next business day.

For real estate loans, please contact the branches directly for an application.

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act 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, physical address, date of birth, and tax payer identification number (Social Security #) and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.

Loan Information

Are you applying as an individual or with a co-applicant? Individual Joint - by selecting joint, we affirm our intent to apply for joint credit.

Loan Purpose Amount Requested Term Requested (months)

Will the loan proceeds be used towards a hemp related business or product? Yes No This includes but is not limited to: general retail sales of CDB Oil, Dispensary Sales of CBD oil, Pharmacy Sale of CBD oil, Online sales of CBD oil and Hemp producers of fibers, textiles, seed, meal, oil, imports or exports.

Please explain your involvement with hemp

Will the loan proceeds be used towards a marijuana related business or product? Yes No This includes but is not limited to: adult or medical use, retail, processing, cultivation, testing, operations that support marjiuana businesses, landlords of a marijuana business, etc.

Please explain your involvement with marijuana

Primary Applicant

First Name Middle Name Last Name Social Security Number Birth Date Mother's Maiden Name Birth City Birth State Number of Dependents Ages of Dependents Primary Phone Number Secondary Phone Number E-mail Address Present Address City State Zip Code Mailing address is different than street address.

Mailing Address City State Zip Code

Is your present address your permanent address? Yes No

How long have you been at your present address? Less than 1 year 1 - 2 year 3 - 5 years 5+ years

Marital Status Married Separated Unmarried (including single, divorced, or widowed)

Nearest Relative Not Living With You Relationship (of Relative) Phone Number (of Relative) Address (of Relative) City (of Relative) State (of Relative) Zip Code (of Relative)

Employment/Income Information of Primary Applicant

Name of Current Employer Employer's Address City State Zip Code Gross Annual Salary

Full Time Yes No

Occupation/Position How long with present employer? Sources of Other Income Amount of Other Income NOTICE: Alimony, Child Support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying the obligation.

Is your alimony, child support, or separate maintenance income received under Court Order Written Agreement Oral Understanding Not Applicable

Joint Applicant

Is your present address your permanent address? Yes No

How long have you been at your present address? Less than 1 year 1 - 2 year 3 - 5 years 5+ years

Marital Status Married Separated Unmarried (including single, divorced, or widowed)

Nearest Relative Not Living With You Relationship (of Relative) Phone Number (of Relative) Address (of Relative) City (of Relative) State (of Relative) Zip Code (of Relative)

Employment/Income Information of Joint Applicant

Name of Current Employer Employer's Address City State Zip Code Gross Annual Salary

Full Time Yes No

Is your alimony, child support, or separate maintenance income received under Court Order Written Agreement Oral Understanding Not Applicable

Financial Information

Do you have a checking account? Yes No

Checking Account Number Financial Institution

Do you have a savings account? Yes No

Savings Account Number Financial Institution

Active Duty

I am a regular or reserve member of the Air Force, Army, Coast Guard, Marine Corps, Navy, or Space Force on active duty or a dependent of a member of the Armed Forces on active duty (a dependent is the member's spouse, member's child under 18 years of age, or an individual for whom the member provides over half their financial support for 180 days immediately preceding today's date.) I AM NOT a regular or reserve member of the Air Force, Army, Coast Guard, Marine Corps, Navy, or Space Force on active duty.

Assets Owned

Do you own any assets? Yes No

Description of Asset: Examples- Cash, Automobiles (make, model, year), Life Insurance (issuer, face value), Real Estate (location, date aquired), Marketable Securities (issuer, type, number of shares), etc.) Value

Subject to Debt Yes No

Name(s) of Owner(s)

Outstanding Debt

Do you have any outstanding debt? Yes No

Description of Debt: Examples- Charge Accounts, Installment contracts, credit cards, etc. Original Debt Present Balance Monthly Payment Name in which account is carried

Past Due Yes No

Housing Debt

Do you have any housing debt (Rent or Mortgage)? Yes No

Landlord/ Mortgage Holder

Rent or Mortgage Payment Rent Mortgage

Original Debt Monthly Payment Name in which account is carried

Additional

My auto insurance agent is: (Name and Address)

I have additional questions or requests Yes No

Please explain

I am aware that I may be required to provide a copy of my Photo ID and social security card before loan processing.

We will contact you upon receiving your application to schedule a time that is convenient to finish loan processing procedures.

Which branch would you like to come into for your loan interview? Bowman Scranton Hettinger Regent

Endorsement

The purpose of this questionnaire is to begin the application process. All applications are subject to approval and will be contacted to schedule a time that is convenient to finish loan procedures.

I certify that everything I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. By signing below, I authorize you to check my credit and employment history and to answer any questions about your credit experience with me.

By entering my name below, I hereby give the electronic equivalent of my signature.

Primary Account Holder's Signature Date Co-Applicant's Signature Date

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