Consumer Credit Application

Important Applicant Information: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

Type of Credit Requested Secured Unsecured

Type of Credit Requested Individual Credit - relying solely on my income or assets Individual Credit - relying on my income or assets as well as income or assets from other sources, including community property Joint Credit - We intend to apply for joint credit

Initials Amount Requested For How Long Payment Date Desired

Desired Repayment Monthly Other

If Other explain: Proceeds of Loan to Be Used For

For Creditor Use Only

Date Account No

Approved Declined

Section A - Individual Applicant Information

Name (First, Middle, Last) Birth Date Telephone Number Email Address Cell Phone Number Driver's License No Social Security Number Number of Dependents Ages of Dependents (e.g. 3, 9, 16) Physical Address (Street, City, State, & ZIP) County Mailing Address (Street, City, State, & ZIP) County

Do you: Own Rent

How Long

(Complete if less than 3 yrs at current address)

Previous Address (Street, City, State, & ZIP) County

Do you: Own Rent

How Long Employer (Company Name & Address) How Long Business Phone Position or Title Salary / Month Gross $ Net $

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 this obligation.

Alimony, child support, separate maintenance received under Court Order Written Agreement Oral Understanding

Sources of Other Income Amount per Month $

Is any income listed in this section likely to be reduced before the credit requested is paid off? No Yes

(If Yes, Explain)

Have you previously received credit from us? No Yes

(If Yes, When) Name & address of nearest relative not living with you Relationship Telephone

Section B - Joint Applicant or Other Party Information

Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.

Name (First, Middle, Last) Birth Date Telephone Number Email Address Cell Phone Number Driver's License No Social Security Number Relationship to Applicant Number of Dependents Ages of Dependents (e.g. 3, 9, 16) Physical Address (Street, City, State, & ZIP) County Mailing Address (Street, City, State, & ZIP) County

Do you: Own Rent

How Long

(Complete if less than 3 yrs at current address)

Previous Address (Street, City, State, & ZIP) County

Do you: Own Rent

How Long Employer (Company Name & Address) How Long Business Phone Position or Title Salary / Month Gross $ Net $

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 this obligation.

Alimony, child support, separate maintenance received under Court Order Written Agreement Oral Understanding

Sources of Other Income Amount per Month $

Is any income listed in this section likely to be reduced before the credit requested is paid off? No Yes

(If Yes, Explain)

Have you previously received credit from us? No Yes

(If Yes, When) Name & address of nearest relative not living with you Relationship Telephone

Section C - Marital Status

Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested.

Applicant Married Separated Unmarried (includes single, divorced and widowed)

Other Party Married Separated Unmarried (includes single, divorced and widowed)

Section D - Assets & Debt Information

If Section B has been completed, this section should be completed giving information about both the Applicant and Joint Applicant or Other Person.

Please mark Applicant-related information with an "A". If Section B was not completed, only give information about the Applicant in this section.

Assets Owned

(Use a separate sheet if necessary.)

Description of Assets	Name in Which the Account is Carried	Subject to Debt?	Value $
Checking Account Number(s) Name of Financial Institution	Name in Which the Account is Carried	Subject to Debt?	Value $
Savings Account Number(s) Name of Financial Institution	Name in Which the Account is Carried	Subject to Debt?	Value $
Certificate of Deposit(s) Name of Financial Institution	Name in Which the Account is Carried	Subject to Debt?	Value $
Marketable Securities - Issuer Type, no. of shares	Name in Which the Account is Carried	Subject to Debt?	Value $
Real Estate (homestead, rental, other) Address	Name in Which the Account is Carried	Subject to Debt?	Value $
Life Insurance - Issuer Face value	Name in Which the Account is Carried	Subject to Debt?	Value $
Automobiles - Make Model, year	Name in Which the Account is Carried	Subject to Debt?	Value $
Other Description	Name in Which the Account is Carried	Subject to Debt?	Value $
			Total Assets $

Outstanding Debts

(Include charge accounts, installment contracts, credit cards, rent, mortgages and other obligations.Use separate sheet if necessary.)

Creditor	Account Number	Name in Which the Account is Carried	Original Amount	Present Balance	Monthly Payments
Landlord or Mortgage Holder	Rent Payment Mortgage	Name in Which the Account is Carried	(Omit Rent)	(Omit Rent)	Monthly Payments
Automobiles (describe)	Account Number	Name in Which the Account is Carried	Original Amount	Present Balance	Monthly Payments
Other	Account Number	Name in Which the Account is Carried	Original Amount	Present Balance	Monthly Payments
Creditor	Account Number	Name in Which the Account is Carried	Original Amount	Present Balance	Monthly Payments
Creditor	Account Number	Name in Which the Account is Carried	Original Amount	Present Balance	Monthly Payments
Creditor	Account Number	Name in Which the Account is Carried	Original Amount	Present Balance	Monthly Payments
Creditor	Account Number	Name in Which the Account is Carried	Original Amount	Present Balance	Monthly Payments
		Total Debts	Original Amount	Present Balance	Monthly Payments

Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable):

Are you obligated to make Alimony, Support or Maintenance Payments? No Yes

If yes, to (Name & Address) Amt. per month $

Are you a co-maker, endorser, or guarantor on any loan or contract? No Yes

If yes, for whom? To whom?

Are there any unsatisfied judgments against you? No Yes

If yes, to whom owed? Amount $

Have you been declared bankrupt in the last 10 years? No Yes

if yes, where? Year?

Section E - Secured Credit

Complete only if credit is to be secured. Briefly describe the property to be given as security:

Property Description Names & Addresses of All Co-Owners of the Property If the security is real estate, give the full name of your spouse (if any)

Disclosures & Acknowledgment

E-Sign Disclosure and Consent

This E-Sign Disclosure and Consent (“Disclosure”) applies to services offered or accessible through online applications and/or the loan application process that are not otherwise governed by the terms and conditions of a separate electronic disclosure and consent. The words “we,” “us,” and “our” refer to First National Bank of Giddings and the entity with whom you have your home loan application and/or account(s), and the words “you” and “your” mean you, the individual(s) ore entity indentified on the application(s) and/or account(s). As used in the Disclosure, “Application” means the loan application you have with us. As used in the Disclosure, “Account” means the account you have with us. “Communication” means information that we need to deliver to you the customer; such as but not limited to, disclosures and other loan documents.

Scope of Communications to Be Provided in Electronic Form. You agree that we may provide you with any Communications that we may choose to make available in electronic format, to the extent allowed by law. Your consent to receive electronic communications and transactions includes, but is not limited to:
- All legal and regulatory disclosures and communications associated with the Application(s), Account(s), or product or service. As an example, First National Bank of Giddings may choose to send by e-mail legally required disclosures for your Application(s) or notification of changes to terms and conditions in relation to your loan application.
- Privacy policies and notices.
- The appraisal performed by the approved third-party vendor.
- Your Notice of Special Flood Hazard Areas and cover letter.
- Notices or disclosures about a change in the terms if your Account(s) or associated payment features and responses to claims.
- Billing or account statements for your Account(s) or such other Communications that we may include from time to time.
Method of Providing Communications to You in Electronic Form. All Communications that we provide to you in electronic form will be provided either (1) via email, (2) by access to a web site that we will designate in an e-mail notice we send to you at the time the information is available, or (3) to the extent permissible by law, by access to a web site that we will generally designate in advance for such purpose.
How to Withdraw Consent. You may withdraw your consent to receive Communications in electronic form by calling us at 979-542-1200. At our option, we may treat your provision of an invalid e-mail address, or the subsequent malfunction of a previously valid e-mail address, as a withdrawal of your consent to receive electronic Communications. We will not impose any fee to process the withdrawal of your consent to receive electronic Communications. The withdrawal of consent made by any borrower on a loan application shall be considered a withdrawal of consent by all co-borrowers. Any withdrawal of your consent to receive electronic Communications will be effective only after we have a reasonable period of time to process your withdrawal.
How to Update Your Records. It is your responsibility to provide us with true, accurate and complete e-mail address, contact, and other information related to providing Communication(s) on your Account(s) and/or Application(s), and to maintain and update promptly any changes in this information. You can update information (such as your e-mail address) by calling us at 979-542-1200.
Hardware and Software Requirements. In order to access, view, and retain electronic Communications that we make available to you, you must have:
- Sufficient electronic storage capacity on your computer’s hard drive or other data storage on unit;
- An e-mail account with an Internet service provider and e-mail software in order to participate in our electronic Communications programs;
- A personal computer with an operating system and telecommunications connections to the Internet capable of receiving, accessing, displaying, and either printing or storing Communications received from us in electronic form via a plain text-formatted e-mail or by access to our web site using one of the browsers specified below;
- Adobe Reader version 8.0 or higher;
Communications in Writing. All Communications in either electronic or paper format should print or download for your records a copy of this Disclosure and any other Communication that is important to you.
Federal Law. You acknowledge and agree that your consent to electronic Communications is being provided in connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures in Global and National Commerce Act, and that you and we both intend that the Act apply to the fullest extent possible to validate our ability to conduct business with you by electronic means.
Termination / Changes. We reserve the right, in our sole discretion, to discontinue the provision of your electronic Communications, or to terminate or change the terms and conditions on which we provide electronic Communications. We will provide you with notice of any such termination or change as required by law.

Signatures -

I certify that everything I have stated in this application and on any attachments is correct.Lender may keep this application whether or not it is approved.By signing below I authorize Lender to check my credit and employment history and to answer questions others may ask Lender about my credit record with Lender.I understand I must update credit information at Lender's request if my financial condition changes.

Applicant's Signature Date

Other Signature (Where Applicable) Date

I certify the information above is correct and ready for submission.

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