Consumer Loan Application

Loan Information

Are you applying as an individual or with a co-applicant?

We intend to apply for joint credit. By initialing, we acknowledge the intention to apply for joint credit on today’s date.

Is this a Secured or Unsecured loan?
Is this loan for a Purchase, Refinance or Other?

Collateral Information

Applicant

How would you prefer to be contacted?

Housing Status

Housing Status

Employment

Employment
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.

Other Income Information

Other 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.

Financial Information

Do you have a checking account?
Do you have a savings account?

Co-Applicant

How would you prefer to be contacted?

Housing Status

Housing Status

Employment

Employment
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.

Other Income Information

Other 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.

Financial Information

Do you have a checking account?
Do you have a savings account?

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?

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your bank 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.

Agreement/Signature

Everything that I/We have stated in this application and on any attachments is correct to the best of my/our knowledge. I understand that Pine Island Bank will retain this application whether or not it is approved and Pine Island Bank is authorized to check my credit and employment history and to answer questions others may ask Pine Island Bank about my credit record with Lender. I understand that I must update credit information at Pine Island Bank's request if my financial condition changes. A person supplying a false material statement that is believed not to be true with respect to information requested on the application form is guility of perjury. MS 48.512, Subd 2.