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.

Loan Information

Type of Credit Requested Individual Credit - Relying solely on my income or assets Joint Credit - We intend to apply for joint credit

Initials Joint Initials Requested Loan Amount Requested Loan Term Proceeds of Loan to Be Used For

Individual Applicant Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Home Phone Number E-mail Address Home Address City State Zip Code Mailing address is different than street address.

Mailing Address City State Zip Code

Nearest Relative

Name of Nearest Relative Not Living With You Phone Number of Nearest Relative Not Living With You Address of Nearest Relative Not Living With You City State Zip Code

Housing Status

Housing Status Own Rent Other

Explain

Have you lived here for two or more years? Yes No

Previous Home Address City State Zip Code

Individual Applicant Employment Information

Is the Applicant employed? 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 two years? (No if unemployed) Yes No

Previous Employer 1

Employment Start Date Employment End Date Gross Monthly Income Position or Title Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Does the second employer provide at least a total of the last 2 years of employment? (No if unemployed) Yes No

Previous Employer 2

Employment Start Date Employment End Date Gross Monthly Income Position or Title Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Please Note: 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

Joint Applicant or Other Party Information

First Name Middle Initial Last Name Birth Date Social Security Number Home Phone Number E-mail Address Home Address City State Zip Code Mailing address is different than street address.

Mailing Address City State Zip Code

Nearest Relative

Name of Nearest Relative Not Living With You Address of Nearest Relative Not Living With You City State Zip Code

Housing Status

Housing Status Own Rent Other

Explain

Have you lived here for two or more years? Yes No

Previous Home Address City State Zip Code

Joint Applicant or Other Party Employment Information

Is the Joint Applicant or Other Party employed? 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 two years? (No if unemployed) Yes No

Previous Employer 1

Employment Start Date Employment End Date Gross Monthly Income Position or Title Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Does the second employer provide at least a total of the last 2 years of employment? (No if unemployed) Yes No

Previous Employer 2

Employment Start Date Employment End Date Gross Monthly Income Position or Title Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Please Note: 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

Marital Status

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

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

Assets

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required.

Checking or Savings Accounts

Account Number	Institution	Cash or Market Value
Account Number	Institution Name	Total Value
		Subtotal Liquid Assets

Real Estate Owned

Property Address Type of Property Estimated Market Value Mortgage Balance Mortgage Payments Property Taxes Insurance

Subtotal Real Estate Market Values

Automobiles owned

Make	Model	Year	Cash or Market Value
Make	Model	Year	Total Value

Other Assets (itemize)

Asset Description	Cash or Market Value
Asset Description	Total Value

Assets Total

Liabilities

Liability

Creditor Creditor/Company Owed Monthly Payment Unpaid Balance

Alimony/Child Support/Separate Maintenance

Expense	Total Owed	Monthly Payment
Alimony	Total Owed	Monthly Payment
Child Support	Total Owed	Monthly Payment
Job-Related Expenses (child care, union dues, etc.)		Monthly Payment
	Total Liabilities	Total Monthly Payments

Net Worth

Net Worth (Assets minus Liabilities)

Individual Applicant Declarations

Are you obligated to pay alimony, child support, or separate maintenance? Yes No

Explain

Are you a co-maker or endorser on a note? Yes No

Explain

Are there any outstanding judgments against you? Yes No

Explain

Have you been declared bankrupt within the past 10 years? Yes No

Explain

Joint Applicant or Other Party Declarations

Are you obligated to pay alimony, child support, or separate maintenance? Yes No

Explain

Are you a co-maker or endorser on a note? Yes No

Explain

Are there any outstanding judgments against you? Yes No

Explain

Have you been declared bankrupt within the past 10 years? Yes No

Explain

Disclosures

Before submitting your application, please click the hyperlinks below to view required disclosures.

Privacy Notice
Please check here that you have successfully viewed the Privacy Notice. (You must read the document to enable this checkbox.)

E-Sign Agreement
Please check here that you have successfully viewed the E-Sign Agreement. (You must read the document to enable this checkbox.)

Acknowledgement

Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.

Type your name in the box below to represent your electronic signature.

Applicant's Signature Date Joint Applicant's Signature Date

Lender's Signature Date Lender Name

Type the numbers you see above:

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