Auto / Personal Loan Application

Required Field

Document Preparation Fee - $100 at closing, other fees may also apply.

Loan Information

Is this a personal or auto loan?

Auto Loan
Personal Loan

Loan Purpose Amount Requested Type of Collateral Offered

Are you applying as an individual or jointly?

Individual
Joint
Guarantor
Co-signer

Original Applicant Name

Please indicate by your initials if you intend to apply jointly.

Applicant Co-Applicant Please select which location you would like to submit your application to.

Vehicle Loan Information

Auto Purchase Type

New
Used

Year Make Model VIN or Serial Number Mileage Insurance Company Insurance Company Phone Number

Applicant

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name

Please Select an ID Type

Drivers License
State ID
Tribal
Military

Date of Issue

I.D. Number Date of Expiration Current Residency Start Date Address City State Zip Code Mailing Address (if different than home) City State Zip Code Primary Phone Number Work Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted?

Primary Phone
Work Phone
Email
Other

Housing Status

Own
Rent
Other

Estimated Property Value Mortgage Balance Monthly Mortgage or Rent Payment

Applicant Employment

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 three years? (No if unemployed)

Previous Employer (if less than three years at current)

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

Income Information

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

Other Monthly Income Income Source

Financial Information

Do you have a checking account?

Checking Account Number Financial Institution

Do you have a savings account?

Savings Account Number Financial Institution

Co-Applicant

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name I.D. Type I.D. Number Date of Expiration Current Residency Start Date Address City State Zip Code Primary Phone Number Work Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted?

Primary Phone
Work Phone
Email
Other

Housing Status

Own
Rent
Other

Estimated Property Value Mortgage Balance Monthly Mortgage or Rent Payment

Applicant Employment

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 three years? (No if unemployed)

Previous Employer (if less than three years at current)

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

Income Information

Other Monthly Income Income 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.

Financial Information

Do you have a checking account?

Checking Account Number Financial Institution

Do you have a savings account?

Savings Account Number Financial Institution

Credit Reference

List all debts, including second mortgage. Provide additional documentation if needed.

Lender

Name of Lender Address City State Zip Code Account Number Original Loan Amount Loan Balance Monthly Payment

 Add Another Lender Other Monthly obligations (i.e. child support)

Credit Information

Have you or your co-applicant ever declared bankruptcy?

Have you or your co-applicant ever had a judgment?

Have you or your co-applicant ever had a repossession or foreclosure?

Do you expect any disruptions or decreases in income during the term of this loan?

If yes to any of the above, please explain.

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your checking or savings account?

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

Loan Payment Date

Which day of the month would you like your payment on?

IMPORTANT INFORMATION ABOUT THE PROCEDURES FOR OPENING A NEW ACCCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record all information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Independence Bank to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Independence Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I understand that this application will be kept whether or not it is approved. I agree to provide any further information the Bank might require to process my application.

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