Auto / Personal Loan Application

Loan Information

Is this a personal or auto loan? Auto Loan Personal Loan

Loan Term Amount Requested

Are you applying as an individual or with a co-applicant? Individual Co-Applicant

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 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 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

Other Preference

Housing Status

Housing Status Own Rent Other

Explain

Estimated Property Value Mortgage Balance

Residency Start Date Monthly Mortgage or Rent Payment

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 Gross Monthly Income 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

If yes, your spouse also may be required to sign the promissory note

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.

Co-Applicant

How would you prefer to be contacted? Home Phone Work Phone Email Other

Other Preference

Housing Status

Housing Status Own Rent Other

Explain

Estimated Property Value Mortgage Balance

Residency Start Date Monthly Mortgage or Rent Payment

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 Gross Monthly Income 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

If yes, your spouse also may be required to sign the promissory note

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.

Bank Reference

Bank Name Branch Address City State Zip Code Checking Account Number Savings Account Number Add Another Bank Reference.

Credit Reference

List all debts, including second mortgage. Provide additional documentation if needed.

Lender

Name of Lender Address City State Zip Code Account Number Original Loan Amount Loan Balance Monthly Payment Add Another Lender

Credit Information

Have you or your co-applicant ever declared bankruptcy? Yes No

Have you or your co-applicant ever had a judgment? Yes No

Have you or your co-applicant ever had a repossession or foreclosure? Yes No

If yes to any of the above, please explain.

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

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

Co-Applicant's Signature Date