Loan Inquiry

* Required Fields

Loan Information
Loan Type *
 Amount Requested *
REASON FOR PERSONAL LOAN AND DESCRIPTION OF COLLATERAL USED FOR LOAN

Personal Information
First Name *
 MI
Last Name *
 Social Security Number *
Street Address *
 City *
State *
 Zip Code *
Telephone Number *
 Birthdate (Month/Day/Year) *
 E-mail Address

Co-Borrower Personal Information (if applicable)
First Name
MI
Last Name
Social Security Number
Street Address
 City
State
Zip Code
Telephone Number
Birthdate (Month/Day/Year)
E-mail Address

Employment Information
Employer
 Telephone Number
 Supervisor
Street Address
 City
State
 Zip Code
Position/Department
 Length of Employment
 years  months
Income
 Per

THIS IS A LOAN INQUIRY ONLY AND A FULL CREDIT APPLICATION WILL BE REQUIRED.
A loan officer will contact you as soon as possible.

*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.

SUBMISSION OF THIS FORM AUTHORIZES FARMERS & MERCHANTS BANK & TRUST TO VERIFY INFORMATION PROVIDED HEREIN, INLCUDING BUT NOT LIMITED TO EMPLOYMENT AND CREDIT HISTORY.