CONSUMER LOAN APPLICATION
| IMPORTANT APPLICANT INFORMATION:
Federal law requires financial institutions to obtain sufficient
information to verify your identity. You may be asked several
questions and to provide one or more forms of identification to fulfill
this requirement. In some instances we may use outside sources to
confirm the information. The information you provide is protected
by our privacy policy and federal law. |
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TYPE OF CREDIT REQUESTED |
FOR CREDITOR USE |
| IMPORTANT: CHECK (√)
THE APPROPRIATE BOXES |
DATE_______ CLASS NO._____ |
| BELOW AND COMPLETE
THE APPLICABLE SECTIONS |
ACCOUNT NO.____________ |
| []SECURED
[]INDIVIDUAL CREDIT - RELYING SOLELY ON
MY INCOME OR ASSETS |
APPROVED []
BY__________ |
|
[]UNSECURED
[]INDIVIDUAL CREDIT - RELYING ON MY
INCOME OR ASSETS AS WELL AS INCOME OR ASSETS FROM OTHER SOURCES |
DECLINED []
BY___________ |
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[]JOINT CREDIT (INITIALS) |
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| AMOUNT REQUESTED |
FOR HOW LONG |
PAYMENT DATE DESIRED |
WANT TO REPAY |
PROCEEDS LOAN TO BE USED FOR: |
| $ |
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[] MONTHLY |
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[] |
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SECTION A - INDIVIDUAL APPLICANT
INFORMATION |
| NAME (Last, First, Middle) |
| BIRTHDATE |
TELEPHONE NO. |
DRIVER'S LIC. NO. |
SOCIAL SECURITY NO. |
NO. DEPENDENTS |
AGES OF DEPENDENTS |
| ADDRESS (Street, City, State & Zip) |
COUNTY |
Do you [] own
or
[] rent |
HOW LONG |
| PREVIOUS ADDRESS (Street, City, State & Zip)
Complete if less than 3 years at present address |
COUNTY |
Did you [] own
or
[] rent |
HOW LONG |
| EMPLOYER (Company Name & Address) |
HOW LONG |
| BUSINESS PHONE
Ext. |
POSITION OR TITLE |
SALARY PER MONTH
GROSS:$
NET:$ |
| PREVIOUS EMPLOYER (Company Name & Address) |
HOW LONG |
| NAME & ADDRESS OF NEAREST RELATIVE NOT
LIVING WITH YOU RELATIONSHIP TELEPHONE NO.
(Include area code) |
| 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. Alimony, child
support, seperate maintenance received under:
[]Court Order
[]Written Agreement
[]Oral Understanding |
| SOURCES OF OTHER INCOME |
AMOUNT PER MONTH $ |
| Is any income listed in this Section likely
to be reduced before the credit request is paid off?
[] No [] Yes
(Explain) |
Have you previously received credit from us?
[] No [] Yes-when |
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SECTION B - JOINT APPLICANT OR OTHER PARTY
INFORMATION |
|
COMPLETE ONLY IF: FOR JOINT CREDIT, FOR
INDIVIDUAL CREDIT RELYING ON INCOME OR ASSETS FROM OTHER SOURCES, OR
APPLICANT IS MARRIED AND RESIDES IN A COMMUNITY PROPERTY STATE. |
| NAME (Last, First, Middle |
| BIRTHDATE |
TELEPHONE NO. |
DRIVER'S LIC. NO. |
SOCIAL SECURITY NO. |
NO. DEPENDENTS |
AGES OF DEPENDENTS |
| RELATIONSHIP TO APPLICANT (if any) |
PRESENT ADDRESS (Street, City, State & Zip |
HOW LONG |
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SECTION E - SECURED CREDIT (Complete only
if credit is to be secured. Briefly describe the property to be given
as security |
| NAMES & ADDRESSES OF ALL CO-OWNERS OF THE
PROPERTY |
| IF THE SECURITY IS REAL ESTATE, GIVE THE
FULL NAME OF YOUR SPOUSE (if any) |
| SIGNATURES - I certify that everything I
have stated in this application and on any attachments is correct.
Lender
may keep this |
| application whether or not it is approved.
By signing below I authorize lender to check my credit and employment history
and to |
| answer questions others may ask lender about my
credit record with lender. I understand that I must update credit
information |
| at lender's request if my financial condition
changes. |
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Applicant's Signature
Date
Other Signature (Where Applicable) Date |
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EQUAL HOUSING LENDER |
|
MEMBER FDIC |
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