Consumer Loan Application

* Required Field

Loan Information

Purpose *
Amount Requested *
Loan Term *
Detailed Description of Collector Car or Reason for Personal Loan
Year
Make
Model
VIN/SN
Mileage
(put n/a if not applicable)

Personal Information

First Name *
MI
Last Name *
Social Security Number *
Street Address *
City *
State *
Zip Code *
Telephone Number *
Mobile Phone Number
Birthdate (Month/Day/Year) *
E-mail Address

Housing Information

Length of Residence *
 years  months
Housing Status *
Monthly Payment *
Mortgage Holder
Estimated Property Value
Mortgage Balance
 
Previous Address if at current address less than 2 years

Employment Information

Employer
Telephone Number
Supervisor
Street Address
City
State
Zip Code
Position/Department
Length of Employment
 years  months
Income
Per
 
Previous Employer if less than 3 years at current employer

Financial Information

Do you have a Checking Account?
 Yes  No
Checking Account Number
Financial Institution
Do you have a Savings Account?
Yes No
Savings Account Number
Financial Institution

References

Name of a Relative
Relationship to Applicant
Telephone Number
Street Address
City
State
Zip Code
Name of a Personal Friend
Telephone Number
Street Address
City
State
Zip Code


Click here to access the Co-Applicant section or Click "Submit" to finish!


Please select one option below.

If you are applying for an individual account in your own name and relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested.
If you are applying for a joint account that you and another person will use, we intend to apply for Joint Credit.
You are applying for an individual account, but you are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested. Please provide information about the person on whose alimony, support or maintenance payments or income assets you are relying.

*Please Note: Alimony, child support, or maintenance income need not be revealed if you do not wish it to be
considered as a basis for repaying this obligation.

Submission of this form authorizes North Easton Saving Bank to verify information provided herein,
including but not limited to employment credit history.