Consumer Loan Application

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Loan Information Type of Application Marital Status
Auto Loan  Other
Loan Request $ for months
Dealer Purchase   Lease Buyout  Private Purchase  Refinance   Pre-approval   New   Used 
Year
Insurance Co.   
Phone
Individual credit
Joint credit with spouse
Joint credit with

who is not your spouse and must complete a separate application
Married (you may apply for separate or joint credit)
Separated
Unmarried (includes single, divorced, and widowed) List the number of people dependent on you for financial support:

Applicant Information  Referred by:
Name
Social Security Number
DOB
Driver's License
Expiration Date
State
Street Address
City
Country
State
Zip
Time At Present Address
Yrs:  Mos:
Home Phone
Cell Phone
Live with: Own  Parents
Rent     Other
Name & Phone of friend/relative not living with you
Previous Street Address(if less than 2 years current)
City
Country
State
Zip
Time At Present Address
Yrs:  Mos:
Employer's Name
Address
City
Type of Business
Position/Title
E-mail
Work Phone
Time There
Yrs:  Mos:
Monthly Take Home
Do you intend to rely on spouse's earnings to qualify for this loan?  Yes No
If yes, your spouse also may be required to sign the promissory note
Other Income $ per month   
Source:
Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification. Alimony, Child Support or Separate Maintenance receive under:
Court Order
Written Agreement
Oral Understanding
Previous Employer (if less than 3 years at current)
Address
Phone
Position
Time There
Yrs: Mos:
Spouse Information (Complete even if spouse is not applying)
Name
Social Security Number
Date of Birth
Driver's License
Expiration Date
State
Monthly Take Home
Do you intend to rely on spouse's earnings to qualify for this loan?  Yes No
If yes, your spouse also may be required to sign the promissory note
Other Income $ per month   
Source:
Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification. Alimony, Child Support or Separate Maintenance receive under:
Court Order
Written Agreement
Oral Understanding
Employer's Name
Address
City
Type of Business
Position/Title
E-mail
Work Phone
Time There
Yrs:  Mos:
Previous Employer (if less than 3 years at current)
Address
Phone
Position
Time There
Yrs: Mos:
Bank References
Name
Branch/Address
Checking Acc't No.
Savings Acc't No
Name
Branch/Address
Checking Acc't No.
Savings Acc't No
Home Information
Rent  Own First Mortgage Holder or Landlord Address
Purchase Date/House
Purchase Price
Estimated Current Value
Balance Owing
Mortgage No.
Monthly Payment/Rent
Credit Reference (List all debts, including second mortgage).  Attach separate sheet if needed.
Name of Lender
Address
Account No.
Original Amount
Balance
Mo. Payment
           
Auto Loan (Open or Closed)        
           
Have you or your Spouse ever:        
Declared Bankruptcy? Yes No  Had a Judgment? Yes No Had a repossession or foreclosure? Yes No
If yes, please Explain:n:
 
           
Automatic Loan Payment        
Do you want your monthly payment automatically deducted from your the Bank checking or savings account?
Yes, Account # No    
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. Please initial your request.
Agreement/Signature      
I certify that all information provided by me is true, correct and complete. I authorize the Bank to make whatever inquires about me you deem necessary and appropriate for the purposes of evaluating my credit application. including credit reports and contacting my employer. I also authorize the Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles.
X: X:  
Applicants Signature Date Spouses Signature. (Spouse should sign only if applying for a joint credit) Date