Consumer Loan |
|
* indicates a required field |
|
Type of Credit Requested |
IMPORTANT: Check the appropriate boxes below and complete the applicable sections |
Type Of Credit:
|
Individual or Joint Credit:
|
* Amount Requested?: $
* For How Long?:
* Payment Date Desired:
|
Want To Repay:
Monthly
Other, please specify:
|
* Proceeds of loan to be used for:
|
Section A - Individual Applicant Information |
* Name (First, Middle, Last):
|
* Date of Birth:
* Home Phone Number:
|
* Driver's License Number:
* Social Security Number:
|
Number of Dependents and Ages:
|
* Address including City, State, Zip, and County:
|
* Email:
|
* Do you rent or own?
Own
Rent
* How Long? (Specify years or months):
|
Previous Address including City, State, Zip, and County:
|
How Long? (Specify years or months):
|
* Name of Nearest Relative Not Living With You:
* Relationship:
|
* Nearest Relative Address:
* Relative Phone No.:
|
|
* Your Employer:
* Employer Address:
|
* How Long? (specify years or months):
* Business Phone Number:
|
* Position:
* How Often Paid:
* Gross Salary per Month:
|
Previous Employer:
Address:
|
How long were you employed? (specify years or months):
|
|
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, separate maintenance received under: |
|
Alimony
Child Support
Seperate Maintenance |
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,
please explain:
|
Have you previously received credit from us? |
No
Yes-When?
|
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 (First, Middle, Last):
|
Date of Birth:
Home Phone Number:
|
Driver's License Number:
Social Security Number:
|
Email:
|
Relationship To Applicant (if any):
|
Number of Dependents and Ages:
|
Address including City, State, and Zip:
|
How Long? (Specify years or months):
|
|
Employer:
Employer Address:
|
How Long? (specify years or months):
Business Phone Number:
|
Position:
How Often Paid:
Gross Salary per Month:
|
Previous Employer:
Address:
|
How long were you employed? (specify years or months):
|
|
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, separate maintenance received under: |
|
Alimony
Child Support
Seperate Maintenance |
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,
please explain:
|
Have you previously received credit from us? |
No
Yes-When?
|
Section C - Marital Status |
Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested. |
|
Applicant:
Married
Separated
Unmarried (including single, divorced, and widowed) |
Other Party:
Married
Separated
Unmarried (including single, divorced, and widowed) |
Section D - Asset and Debt Information |
Assets Owned |
If Section B has been completed, this Section should be completed giving information about both the Applicant and Joint Applicant or Other Person. Please mark Applicant-related information with an "A." If Section B was not completed, only give information about the Applicant in this Section. |
|
|
Outstanding Debts |
(Include charge accounts, installment contracts, credit cards, rent, mortgages, and other oblligations.) |
|
|
Complete the following information about both the applicant and Joint Applicant or Other Person (if applicable). Also, please don't use commas or dollar signs in the dollar amount fields: |
|
Are you obligated to make Alimony, Support, or Maintenance Payments?
|
If yes, to (Name & Address)
Amount per month $
|
Are you a co-maker, endoser or guarantor on any loan or contract?
|
If yes, for whom?
To Whom?
|
Are there any unsatisfied judgements against you?
|
If yes, to whom owed?
Amount $
|
Have you been declared bankrupt in the last 10 years?
|
If yes, where?
Year?
|
Section E - Secured Credit |
Complete only if credit is to be secured. Briefly describe the property to be given as security. |
Property Description:
|
Name and Address of Property Owner 1
|
Name and Address of Property Owner 2
|
Name and Address of Property Owner 3
|
|
Which branch will you be opening your loan at?
|
|
|