PERSONAL LOAN APPLICATION

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

We intend to apply for joint credit.

SECTION A - APPLICANT

ARE YOU A U.S. CITIZEN?

MY PRINCIPAL FINANCIAL INSTITUTION IS:

Services presently used

No.

No.

Have you ever applied to us for a loan?

If Yes, When?

SECTION B – INCOME AND EMPLOYMENT

SALARY AND WAGES

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)

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

SECTION C – 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

(omit rent)

(omit rent)

TOTALS

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

When?

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

If this Section of Application is completed, the indebtedness of Co-Applicant/Guarantor/Endorser must be shown under the “liabilities and Indebtedness” Section above. (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)

ARE YOU A U.S. CITIZEN?

MY PRINCIPAL FINANCIAL INSTITUTION IS:

Services presently used

No.

No.

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

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