Loan Application

Loan Information

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

Purpose Purchase Automobile Refinance Personal Line Overdraft Protection Commercial/Agriculture Home Equity Line of Credit

Amount Requested Detailed Description of Collateral or Reason for Loan

Today's Date

Month Day Year

Vehicle Information

Auto Loan Purpose Year Make Model VIN or Serial Number Mileage Give a detailed description of collector car or reason for personal loan.

Personal Information

First Name Middle Initial Last Name Social Security Number Street Address City State Zip Code Telephone Number Birthday Month Birthday Day Birthday Year E-mail Address

Housing Information

Housing Status Own Rent Live with Parents Other

Monthly Payment Mortgage Holder Estimated Property Value Mortgage Balance

Length of Residence

Years Months

Employment

Provide at least 2 years of current and previous employment.

Employer

Employer Employer's Phone Number Employer's Address City State Zip Code Position or Title Income Per Average hours worked per week

Length of Employment

Years Months

Are you still employed with this employer? Yes No

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

Reference

Full Name Relationship to Applicant Telephone Number Street Address City State Zip Code

Co-Applicant Information

First Name Middle Initial Last Name Social Security Number Street Address City State Zip Code Telephone Number Birthday Month Birthday Day Birthday Year E-mail Address

Housing Information

Housing Status Own Rent Live with Parents Other

Monthly Payment Mortgage Holder Estimated Property Value Mortgage Balance

Length of Residence

Years Months

Employment

Provide at least 2 years of current and previous employment.

Employer

Employer Employer's Phone Number Employer's Address City State Zip Code Position or Title Income Per Average hours worked per week

Length of Employment

Years Months

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

Reference

Full Name Relationship to Applicant Telephone Number Street Address City State Zip Code

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