CONSUMER LOAN APPLICATION



CREDIT REQUESTED

Account Requested *
Individual Joint
 
We intend to apply for joint credit.

Applicant *

Co-Applicant
Amt. Requested *
# of Payments *
Preferred Pmt. Amt. *
Preferred Pmt. Day
Market Survey
Specific Purpose of Loan *
Collateral Offered
Dealer Name - if applicable

COMPLETION INSTRUCTIONS FOR APPLICANT

Complete the Applicant Information section for the first applicant. Mark the appropriate box to indicate whether the Applicant is applying as a Borrower, Cosigner, Guarantor, Grantor (of collateral), or Other for a different capacity. If the applicant is married, he or she may apply for individual credit.

APPLICANT INFORMATION

Borrower   Cosigner   Guarantor   Grantor   Other  
 
Applicant's Full Name (First M.I. Last) *
Social Security Number *
Cell Phone *
 
Home Phone *
 
Date of Birth *
Driver's
License Number *
 
Ages of Dependents
 
Years of Education
Years in
Current Profession
 
Email Address

ADDRESS INFORMATION

Home Street Address (If rural, show Road or Box No) *
City *
State *
Zip: *
Since *
 
Own   Rent
Mailing Address (Street or P.O. Box, City, State, Zip Code)
Previous Home Address (Street, City, State, Zip Code)
From
To

EMPLOYMENT INFORMATION

Applicant's Employer (If Self-Employed, Name and Nature of Business) *
Business Address (Street, City, State, Zip Code) *
Type of Business *
Supervisor *
Phone Number *
Title / Position *
Since *
Salary *
per
Applicant's Employer (If Self-Employed, Name and Nature of Business)
Business Address (Street, City, State, Zip Code)
Type of Business
Supervisor
Phone Number
Title / Position
Since
Salary
per

COMPLETION INSTRUCTIONS FOR CO-APPLICANT

(a) If you are applying for joint credit or will be permitted to use the account, complete the Co-Applicant Information section as a Borrower. (b) If the Applicant is applying for individual credit, but 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, complete the Co-Applicant Information section, to the extent possible, providing information about the person on whose alimony, child support or separate maintenance payments or income or assets the Applicant is relying. (c) If the Applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested, complete the Co-Applicant Information section with regard to the Applicant's spouse.

CO-APPLICANT INFORMATION

Borrower   Cosigner   Guarantor   Grantor   Other  
 
Applicant's Full Name (First M.I. Last)
Social Security Number
Cell Phone
 
Home Phone
 
Date of Birth
Driver's
License Number
 
Ages of Dependents
 
Years of Education
Years in
Current Profession

ADDRESS INFORMATION

Home Street Address (If rural, show Road or Box No)
City
State
Zip:
Since
 
Own   Rent
Mailing Address (Street or P.O. Box, City, State, Zip Code)
Previous Home Address (Street, City, State, Zip Code)
From
To

EMPLOYMENT INFORMATION

Applicant's Employer (If Self-Employed, Name and Nature of Business)
Business Address (Street, City, State, Zip Code)
Type of Business
Supervisor
Phone Number
Title / Position
Since
Salary
per
Applicant's Employer (If Self-Employed, Name and Nature of Business)
Business Address (Street, City, State, Zip Code)
Type of Business
Supervisor
Phone Number
Title / Position
Since
Salary
per

SCHEDULE OF OTHER INCOME

Notice: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Alimony, child support, separate maintenance received under   Court Order   Written Agreement   Oral Understanding   Other
 
PARTIES   INCOME TYPES:  A = Alimony / Child Support  B = Business  C = Commissions  I = Interest & Dividends
O = Overtime  R = Retirement  X = Other
 
App
 
CoA
 
Joint
   
Type
 
Description
 
Amount
 
Frequency
 
 
 

SCHEDULE OF EXPENSES

PARTIES   EXPENSE TYPES:  D = Dues - Homeowners Association  H = Hazard Insurance  P = Private Mortgage Insurance  R = Rent
T = Taxes (Property)  U = Utilities  A = Alimony / Child Support  C = Child / Dependent Care  E = Estimated Living Expenses
F = Federal & State Taxes  I = Insurance Payments  M = Medical  O = Other
 
App
 
CoA
 
Joint
   
Type
 
Description
 
Amount
 
Frequency
 
 
 
 
 

SCHEDULE OF LIABILITIES (NON-REAL ESTATE)

PARTIES   LIABILITY TYPES:  A = Automobile Loans  I = Installment / Revolving
T = Third Party Obligations (As Co-Maker or Guarantor)  O = Other
 
App
 
CoA
 
Joint
   
Type
 
Creditor Name
 
Account Number
 
Original Balance
 
Current Balance
Payments
Remaining
 
Payment Amount
  per
  per
  per

SCHEDULE OF ASSETS (NON-REAL ESTATE)

PARTIES   ACCOUNT TYPES:  C = Checking  T = Time Certificate of Deposit  I = IRA / SEP  L = Life Insurance
M = Money Market  R = Retirement  S = Savings  O = Other
App CoA Joint   Type Description Financial Institution Account Number Current Balance Subject
to Debt
 
 
 

SCHEDULE OF REAL ESTATE OWNED

PARTIES   TYPES:  S = Single Family  D = Duplex  T = Triplex  C = Condominium  P = P.U.D  L = Land  O = Other / Summary
App
CoA
Joint
  Type
Property Disposition
Sold   Pending Sale   Rental   N / A
  Description
Property Address
Date Acquired
Cost
Principal Residence
Yes   No  
   
Current Market Value
 
Total Mortgages & Liens
Gross
Rental Income
Taxes, Insurance
& Maintenance
 
Net Rental Income
  Creditor 1 Name and Address
Unpaid Balance
Payment Amount
per
Lien Position
First
Lien
Junior
Lien
  Creditor 2 Name and Address
Unpaid Balance
Payment Amount
per
Lien Position
First
Lien
Junior
Lien
 
App
CoA
Joint
  Type
Property Disposition
Sold   Pending Sale   Rental   N / A
  Description
Property Address
Date Acquired
Cost
Principal Residence
Yes   No  
   
Current Market Value
 
Total Mortgages & Liens
Gross
Rental Income
Taxes, Insurance
& Maintenance
 
Net Rental Income
  Creditor 1 Name and Address
Unpaid Balance
Payment Amount
per
Lien Position
First
Lien
Junior
Lien
  Creditor 2 Name and Address
Unpaid Balance
Payment Amount
per
Lien Position
First
Lien
Junior
Lien

QUESTIONS

Applicant (1) Applicant (2)   Explanation
(Please provide additional information if necessary)
Yes No Yes No  
* Are there any outstanding judgments against you?
* Have you ever been declared bankrupt?
* Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
* Are you party to a lawsuit?
* Are you obligated on any loan resulting in judgment, foreclosure or title transfer?
* Are you delinquent/in default on any Federal debt, financial obligation, bond or loan guarantee?
* Are you obligated to pay alimony, child support or separate maintenance?
* Is any part of the down payment borrowed?
* Are you a co-maker or an endorser on a loan?
* Have you ever had merchandise repossessed?
* Have you ever been denied credit with this institution?
* Are you a U.S. citizen?
If no, are you a resident alien?
If no, are you a non-resident alien?

CREDIT LIFE AND DISABILITY INSURANCE

Applicant desires the following voluntary insurance: Credit Life Credit Disability
Co-Applicant desires the following voluntary insurance: Credit Life Credit Disability

APPLICANT SIGNATURE(S)

I/we hereby apply for the loan or credit described in this application. I/we certify that I/we made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information. I/we agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for the purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my/our account. I/we understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/we further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.
APPLICANT:

X   X
  Applicant * Date *   Co-Applicant Date

FOR LENDER'S USE ONLY

Officer No./Name
Approved By
Concurrence By (if needed)
Committee Date
Decision Date
Department Date
Application Date
Application No.
Commitment No.
Loan No.

Decision and Comments: Approved Denied Incomplete Counteroffer Conditional Approval Withdrawal Other

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