Plains State Bank
 

Loan Information

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

Personal Information

First Name
MI
Last Name Social Security Number
Street Address City State Zipcode
Telephone Number Birthdate (Month/Day/Year) E-mail Address
 

Housing Information

Length of Residence Housing Status Monthly Payment
Mortgage Holder Estimated Property Value Mortgage Balance
 

Employment Information

Employer Telephone Number Supervisor
Street Address City State Zipcode
Position/Department Length of Employment Income Per
 

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 Zipcode
Name of a Personal Friend Address (Street, City, State, Zip) Telephone Number

CLICK HERE to access the Co-Applicant section or Click "Submit" below to finish!

* 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 Plains State Bank to verify information provided herein, including but not limited to employment and credit history.

 

This application is not for consumer purpose mortgage loans. For loans that use real property or a primary residence to secure a consumer loan, please contact your local Plains State Bank for more information.

 

 

 

 

 

 

 

Plains State Bank
 
We intend to apply for joint credit
  Applicant Co-Applicant
 
If you are applying for a joint account or an account that you and another person will use, complete all sections providing information in B about the joint applicant or user.
 

Personal Information

Relationship to Applicant 

First Name
MI
Last Name Social Security Number
Street Address City State Zipcode
Telephone Number Birthdate (Month/Day/Year) E-mail Address
 

Housing Information

Length of Residence Housing Status Monthly Payment
Mortgage Holder Estimated Property Value Mortgage Balance
 

Employment Information

Employer Telephone Number Supervisor
Street Address City State Zipcode
Position/Department Length of Employment Income Per
 

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 Zipcode
Name of a Personal Friend Address (Street, City, State, Zip) Telephone Number

* 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 Plains State Bank to verify information provided herein, including but not limited to employment and credit history.

 

This application is not for consumer purpose mortgage loans. For loans that use real property or a primary residence to secure a consumer loan, please contact your local Plains State Bank for more information.