Auto and Personal Loan Request Form

Required Field

Loan Information

Will your loan request be as an individual or with a co-applicant?

Individual
Co-Applicant

What type of loan are you looking for?

Purchase
Refinance
Pre-Approval
Other

Describe what you want to finance (For Example: vehicle, camper, recreational vehicle, debt consolidation, etc.): What is most important to you? Amount Requested

Applicant

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Home Address City State Zip Code Cell Phone Number Work Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted?

Cell Phone
Work Phone
Email
Other

Do you currently have accounts with First National Bank?

Which branch do you/would you bank with most often?

Bluffton
Findlay-Tiffin Avenue
Findlay-Trenton Avenue
Lima-Eastown Road
Lima-Bellefontaine Road
Ottawa
Pandora

Housing Status

Own
Rent
Other

Estimated Property Value Mortgage Balance Time at Current Address Monthly Mortgage or Rent Payment

Employment

Employed
Not Employed

Full Time
Part Time

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

Co-Applicant

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Home Address City State Zip Code Cell Phone Number Home 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
Email
Other

Housing Status

Own
Rent
Other

Estimated Property Value Mortgage Balance Time at Current Address Monthly Mortgage or Rent Payment

Employment

Employed
Not Employed

Full Time
Part Time

Endorsement

I certify that everything I have stated in this form is correct. You may keep this form whether or not I complete a loan application.

By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update this credit information at your request and if my financial condition changes.

Applicant's Signature Date Co-Applicant's Signature Date

E-Sign Act Disclosure and Consent

Before proceeding you must confirm that you have read and agree to the terms of the Electronic Signature Act Disclosure available at the link below.

E-Sign Act Disclosure and Consent

I/we confirm that I have read and agree to the terms of the E-SIGN Act Disclosure above. I also agree that the Internet access device(s) I/we will use to receive the related legal disclosures, agreements, online account signature form and the instructions meet(s) the system requirements described in the disclosure presented above; and I/we consent to receiving the related legal disclosures, agreements, online account signature form and the instructions electronically.