Fowler State Bank

Consumer/Personal Loan Application

Loan Information

Loan Purpose Loan Amount Requested $ Number of Months
Collateral Offered if Auto, year/make/model 
Type of Application (select one): Individual Joint

Applicant Information:

Name Social Security Number DOB
Street Address City State Zip Code
Contact Number(s) Email
Name & Phone of friend/relative not living with you
Employer's Name
Phone # Address Position/Title
Time There Yrs: Mos: Rent/Mortgage Payment Gross Monthly Income
Do you pay child support? Yes No    If yes, how much monthly?

Co-Applicant Information:

Name Social Security Number DOB
Street Address City State Zip Code
Contact Number(s) Email
Name & Phone of friend/relative not living with you
Employer's Name
Phone # Address Position/Title
Time There Yrs: Mos: Rent/Mortgage Payment Gross Monthly Income
Do you pay child support? Yes No    If yes, how much monthly?

**Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.

Agreement/Signature

I certify that all information provided by me is true, correct and complete. I authorize Fowler State Bank to make whatever inquiries about me they deem necessary and appropriate for the purposes of evaluating my credit application, including credit reports and contacting my employer. I also authorize Fowler State Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies.

Applicant's Signature Date Co-Applicant's Signature Date