PERSONAL LOAN APPLICATION

IMPORTANT: Read these Directions before completing this Application. Check the Appropriate Box.

If you are applying for individual credit or an individual account, in your own name, and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A-D.

If you are applying for joint credit with another person or for a joint account or an account that you and another person will use, complete all Sections, providing information in Section E about the joint applicant.

We intend to apply for joint credit.

Applicant

Co-Applicant

If you are applying for individual credit or an individual account, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all Sections to the extent possible, providing information in Section E about the person on whose alimony, support, or maintenance payments or income or assets you are relying.

SECTION A - APPLICANT

NAME (Please print full name)

HOME PHONE

CELL PHONE

PRESENT STREET

HOW LONG AT THIS ADDRESS

CITY, STATE, AND ZIP

E-MAIL ADDRESS

IMMEDIATE PREVIOUS ADDRESS

HOW LONG AT THIS ADDRESS

CITY AND STATE

ZIP

SOCIAL SECURITY NUMBER

DRIVERS LICENSE NUMBER – STATE

BIRTH DATE

NO. OF DEPENDENTS – LIST BY AGE

NAME, ADDRESS AND RELATIONSHIP OF TWO NEAREST RELATIVES NOT LIVING WITH YOU OTHER THAN A PRESENT OR FORMER SPOUSE

ARE YOU A U.S. CITIZEN?

Yes

MY PRINCIPAL FINANCIAL INSTITUTION IS:

Services presently used

Checking Account

Savings Account

No.

Safe Deposit

Loan

Cert. of Deposit

OTHER FINANCIAL INSTITUTIONS USED

AMOUNT OF LOAN

REQUESTED MOS. TO PAY

PURPOSE OF LOAN

COLLATERAL OFFERED AND HOW OWNED

Have you ever applied to us for a loan?

Yes

If Yes, When?

SECTION B – INCOME AND EMPLOYMENT

PRESENT EMPLOYER

SALARY AND WAGES

MONTHLY INCOME

EMPLOYER ADDRESS

BUSINESS PHONE

OTHER INCOME – From Whom or Describe (Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation)

MONTHLY INCOME

POSITION OR TITLE

DATE OF EMPLOY

PREVIOUS EMPLOYER AND ADDRESS

POSITION OR TITLE

If you have chosen to disclose income from alimony, child support or separate maintenance, is such income pursuant to:

Written Agreement

Court Decree

Other

YEARS EMPLOYED

TOTAL MONTHLY INCOME

HOW LONG RECEIVED

HOW OFTEN

FROM WHOM

SECTION C – ASSETS

AUTOS ( Make, Model, Year)

TOTAL VALUE

REAL ESTATE (Location)

DATE OCCUPIED

VALUE

OTHER ASSETS (describe)

ESTIMATED VALUE

AUTO INSURANCE AGENTS: (Name and Address)

TOTAL ASSETS

SECTION D – LIABILITIES AND INDEBTEDNESS

List below all indebtedness to banks, credit unions, stores, finance companies, individuals and other creditors, including obligations to pay alimony, child support, separate maintenance, rent, mortgages, etc.

CREDITOR

TYPE OF DEBT OR ACCOUNT NUMBER

ORIGINAL DEBT

PRESENT AMOUNT OWED

COLLATERAL

MONTHLY PAYMENT

LANDLORD OR MORTGAGE HOLDER

Rent Payment

Mortgage

(omit rent)

TOTALS

Have you ever been bankrupt or had any judgments or garnishments against you?

Yes.

When?

LIABILITIES

MONTHLY PAYMENTS

MONTHLY DEBT TO INCOME (%)

ASSETS TO LIABILITIES (%)

SECTION E – JOINT APPLICANT, USER OR OTHER PARTY (Use separate sheets, if needed.)

SIGNATURES

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not loan is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.

APPLICANT’S SIGNATURE

DATE

CO-APPLICANT/GUARANTOR/ENDORSER SIGNATURE (Where Applicable)

DATE

Your content has been submitted.