Fowler State Bank

Consumer/Personal Loan Application

Loan Information

Auto ( or other vehicle) Loan Other Loan Request $ for months
Dealer Purchase Lease Buyout Private Purchase Refinance New Used Year/Make/Model
Insurance Agent Name + Company Insurance Agency Phone
Other Collateral details

Type of Application

Individual credit
Joint credit with spouse
Joint credit with
who is not your spouse and must complete a separate application

Marital Status

Married (you may apply for individual or joint credit)
Separated
Unmarried (includes single, divorced, and widowed)
List the number of people dependent on you for financial support:

Applicant Information:

Name Social Security Number DOB
Driver's License State and Date Issue
Street Address City Country State Zip Time At Present Address Yrs: Mos:
Home Phone Cell Phone   Own  Rent Other Name & Phone of friend/relative not living with you
Previous Street Address(if less than 2 years current) City / State Country State Zip Time At Present Address Yrs: Mos:
Employer's Name Address City Type of Business
Position/Title E-mail Work Phone Time There Yrs: Mos:
Gross Monthly Income Do you intend to rely on spouse's earnings to qualify for this loan? Yes No

If yes, your spouse also may be required to sign the promissory note

Other Income $ per month Source:

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

Previous Employer (if less than 3 years at current)

Employer's Name Phone Position /Title
Address Time There Yrs: Mos:

Co-borrower Information

Name Social Security Number Date of Birth
Driver's License State Address if different from borrower
Gross Monthly Income Do you intend to rely on spouse's earnings to qualify for this loan? Yes No

If yes, your spouse also may be required to sign the promissory note

Other Income $ per month Source:

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

Employer's Name Address City / State Type of Business
Position/Title E-mail Work Phone Time There Yrs: Mos:

Previous Employer (if less than 3 years at current)

Employer's Name Phone Position / Title
Address Time There Yrs: Mos:

Bank References

Name Branch/Address Checking Acc't No. Savings Acc't No.
Name Branch/Address Checking Acc't No. Savings Acc't No.

Home Information

Rent Own First Mortgage Holder or Landlord Address
Balance Owing Mortgage No. Monthly Payment/Rent

Credit Reference (List all debts, including second mortgage). Attach separate sheet if needed.

Name of Lender Address Account No. Original Amount Balance Mo. Payment

Auto Loan (Open or Closed)

Have you or your Co-applicant ever:

Declared Bankruptcy? Yes No
Had a Judgment or Collection item? Yes No
Had a repossession or foreclosure? Yes No
If yes, please Explain:

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your Fowler State Bank checking or savings account?
Yes, Account # No
Automatically transferred funds will be applied as my monthly payment on each monthly due date so long as there are adequate funds on deposit or there is available credit in my account, until the loan is paid or the Bank receives written notice to cancel. I understand the Bank reserves the right to terminate the automatic repayment plan without notice. Please initial your request.

Agreement/Signature

I certify that all information provided by me is true, correct and complete. I authorize Fowler State Bank to make whatever inquries about me you 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.

Applicants Signature Date Co applicant Signature. Date