Personal and Auto Loan Application

Loan Information

Type of Loan Auto Loan Personal Loan

Year Make Model VIN

Type of Personal Loan Secured Unsecured

Please provide the purpose of the loan. Collateral to be Pledged

Amount Requested Number of Monthly Payments Desired (Max 72 Months) Number of Monthly Payments Desired (Max 36 Months)

Is this an application for Joint Credit? Individual Joint Credit

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intent to apply for joint credit (sign below):

Borrower's Signature Co-Borrower's Signature

Applicant I

Name

Preferred Method of Contact Home Phone Cell Phone

Home Phone Cell Phone

Birth Date Social Security Number Email Address Number of Dependents

Housing

Address City State Zip Code Years There Monthly Rent Previous Address City State Zip Code Years There

Employment

Current Employer Phone Business Address City State Zip Code Position Years There Monthly Pay Previous Employer Years There

Financial

Other Income Source Amount

*You are not required to reveal income from child support, alimony or separate maintenance payments.

Bank Account

Bank Name Account Type Balance

Applicant II

Name

Preferred Method of Contact Home Phone Cell Phone

Home Phone Cell Phone

Birth Date Social Security Number Email Address Number of Dependents

Housing

Address City State Zip Code Years There Monthly Rent Previous Address City State Zip Code Years There

Employment

Current Employer Phone Business Address City State Zip Code Position Years There Monthly Pay Previous Employer Years There

Financial

Other Income Source* Amount

*You are not required to reveal income from child support, alimony or separate maintenance payments.

Bank Account

Bank Name Account Type Balance

Credit Information (Applicants I & II)

Show all auto loans, charge accounts, installment debts, education loans, or any other obligations for which you are singly or jointly liable or which you are authorized to use.

Creditor Information

Creditor Name (Indicate name(s) in which debts or accounts appear) Address City State Zip Code Account Number Original Amount Credit Line Unpaid Balance Monthly Payment Check Payoff*

*PLEASE CHECK OFF ITEMS THAT WILL BE PAID OFF WITH THE PROCEEDS FROM THE LINE.

Other

Description of Other Fixed Monthly Obligations (including alimony and child support).

Endorsement

I/We hereby apply for a loan in the amount indicated herein and offer a note signed by me and co-makers (if any) whose names and statements appear herewith and I authorize you to obtain any information that you require concerning such statements, and agree that this application shall remain your property whether the loan is granted or not.

I hereby certify that neither I nor my co-applicant, if any, have or are liable on or for any other loans or obligations, except such as are specifically listed above, that I have read this statement and the answers to the questions in the Applicant Statement above, which were made by me or on my dictation before I signed this Application, that they are true and complete and are made by me for the purpose of obtaining credit and under the penalties of perjury.

Applicant's Signature Date Co-Applicant's Signature Date Type the numbers you see above:

Loan Approved By:

Approver Name