Fowler State Bank


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.

General Information:

Corporate Partnership Sole Proprietor Other

Insurance Information:

Credit References

Primary Lender:

Fertilizer Dealer:

Primary Seed Dealer:

Capital Payment Information

Equipment Payments

Land Payments

  Applicant Co-Applicant
Are you a co-maker, co-signer or guarantor on any loans? Yes No Yes No
Are there any unsatisified judgments against you? Yes No Yes No
Have you declared bankruptcy in the last ten years? Yes No Yes No
Are you a defendant in any pending law suit(s)? Yes No Yes No
Does anyone else own an interest in the property listed? Yes No Yes No
Are any of your assets held in trust? Yes No Yes No
Have you ever applied for a loan or a lease with FSB? Yes No Yes No
Are any of your business or personal accounts past due? Yes No Yes No

Loan Request

Secured Unsecured Initial Request Additional Advance
Purpose of Loan:

Additional Information

Please send your most current Financial Statement and Tax Return to the Bank at:

Fowler State Bank

Attn: Ag Department

P.O. Box 511

Fowler In. 47944


We intend to apply for joint credit. Yes No

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 typing my name below and submitting the form I authorize Lender to check my personal and business credit and employment history and to answer any questions others may ask Lender about my credit record with Lender. I understand that I must update credit information at Lender's request if my financial condition changes.

Name: Date: Name: Date: