Auto / Personal Loan Application

Required Field

Loan Information

Is this a personal, auto or heat loan?

Personal Loan
Auto Loan
Heat Loan

Vehicle New or Used

New
Used

Term = 84
Interest Rate = 0%
Maximum Unsecured $15,000
Additional Conditions and Fees for Loans over $15,000

Loan Term

Amount Requested Purpose of Loan Proceeds

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

Individual
Co-Applicant

Vehicle Loan Information

Auto Purchase Type Year Make Model VIN or Serial Number Mileage Insurance Company Insurance Company Phone Number

Applicant

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Driver's License Number State Issued Date of Expiration Current Residency Start Date Home Address City State Zip Code Cell Phone Number Home Phone Number Work Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted?

Cell Phone
Home Phone
Work Phone
Email
Other
Other Preference

Housing Status

Own
Rent
Other
Explain

Estimated Property Value Mortgage Balance Residency Start Date Monthly Mortgage or Rent Payment

Applicant Employment

Employed
Not Employed

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Have you worked here for more than three years? (No if unemployed)

Previous Employer (if less than three years at current)

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Income Information

Number of Dependents

Do you intend to rely on the co-applicant's earnings to qualify for this loan?

If yes, your spouse also may be required to sign the promissory note

Other Monthly Income Income 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.

Co-Applicant

Co-Applicant Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Driver's License Number State Issued Date of Expiration Current Residency Start Date Home Address City State Zip Code Previous Residency Start Date Previous Home Address City State Zip Code Cell Phone Number Home Phone Number Work Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted?

Cell Phone
Home Phone
Work Phone
Email
Other
Other Preference

Housing Status

Own
Rent
Other
Explain

Estimated Property Value Mortgage Balance Residency Start Date Monthly Mortgage or Rent Payment

Co-Applicant Employment

Employed
Not Employed

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Have you worked here for more than three years? (No if unemployed)

Previous Employer (if less than three years at current)

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Income Information

Number of Dependents

Do you intend to rely on the applicant's earnings to qualify for this loan?

If yes, your spouse also may be required to sign the promissory note

Other Monthly Income Income 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.

Bank Reference

Bank Name Branch Address City State Zip Code Checking or Savings Account Number

Will this be a Checking or Savings account?

Checking
Savings

 Add Another Bank Reference.

Credit Reference

List all debts, including second mortgage. Provide additional documentation if needed.

Lender

Name of Lender Account Number Loan Balance Monthly Payment

 Add Another Lender

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?

If yes to any of the above, please explain.

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your Wrentham Cooperative Bank Or another bank checking or savings account?

Checking or Savings?

Checking
Savings

Bank Name Bank Account Number Routing Number

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

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Wrentham Cooperative Bank to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Wrentham Cooperative Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. If this is an Auto Loan, I also authorize the Bank to obtain address information from the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date Co-Applicant's Signature Date