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Consumer Loan Application

IMPORTANT APPLICANT INFORMATION: Federal law required 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.

TYPE OF CREDIT REQUESTED
Secured
 Individual credit - relying solely on my income or assets
Unsecured Individual credit - relying on my income or assets as well as income or assets from other sources
  Joint credit - We intend to apply for joint credit
Amount requested: $
For how long: months
Payment date desired: day of each month
Want to repay: Monthly | Other:
Loan to be used for:

 

SECTION A - INDIVIDUAL APPLICANT INFORMATION
Name: (Last, First, Middle)
Birthdate:

MM
DD
YYYY
Phone Number: (555) 555-5555
Driver's License Number:
Social Security Number: 555-55-5555
Number of Dependants:
Ages of Dependents: (separate by commas)
   
Address:
(street, city, state & zip)
County:
 How Long:
years
months 		Rent
Own
Previous Address:
(street, city, state & zip)
(complete if less than 3 years at present address)
County:
 How Long:
years
months 		Rent
Own
Employer Name:
Employer Address:

Employed for how long: years
months
Business Phone: ext:
Position/Title:
Salary Per Month: Gross: $ Net: $
Previous Employer Name:
Previous Employer Address:

Employed for how long: years
months
Address of nearest relative not living with you:

Name of nearest relative not living with you:
Relationship to Relative:
Telephone Number (555) 555-5555
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: 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?

 

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:

MM
DD
YYYY
Phone Number: (555) 555-5555
Driver's License Number:
Social Security Number: 555-55-5555
Number of Dependants:
Ages of Dependents: (separate by commas)
Relationship to Applicant:
(if any)
Present Address:
(street, city, state & zip)
How Long:
years
months
Employer Name:
Employer Address:

Employed for how long: years
months
Business Phone: ext:
Position/Title:
Salary Per Month: Gross: $ Net: $
Previous Employer Name:
Previous Employer Address:

Employed for how long: years
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: 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:
Has joint applicant or other party 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 & DEBT INFORMATION
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 the information about the Applicant in this Section.
ASSETS OWNED      
Description of Assets Name in Which the
Account is Carried		 Subject to Debt? Value?
Checking Account Number(s)
(where)
      
Yes | No $
Savings Account Number(s)
(where)
      

Yes | No $
Certificate of Deposit(s)
(where)
      

Yes | No $
Marketable Securities
(issuer, type, number of shares)
      

Yes | No $
Real Estate
(location, date acquired)
      

Yes | No $
Life Insurance
(issuer, face value)
      

Yes | No $
Automobiles
(make, model, year)
      

Yes | No $
Other
(list)		      

Yes | No $
       
TOTAL ASSETS:     $

 

OUTSTANDING DEBTS
(including charge accounts, installment contracts, credit cards, rent, mortgages and other obligations.)
Creditor Account Number Name in Which
the Account
is Carried		 Original Amount
(omit rent)		 Present Balance
(omit rent)		 Monthly Payments
Landlord or Mortgage Holder

Rent Payment
Mortgage		 $ $ $
Automobiles (describe)

$ $ $

$ $ $

$ $ $

$ $ $

$ $ $

$ $ $

$ $ $

$ $ $

$ $ $

$ $ $

$ $ $
TOTAL ASSETS:     $ $ $
 
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable)
Are you obligated to make Alimony, Support
or Maintenance Payments?		 Yes | No  
If yes, to: Name:


Amount per month:
$ 		Address:


Are you a co-maker, endorser, or guarantor on any loan or contract? Yes | No  
If yes: For whom:
 To whom:
Are there any unsatisfied judgements against you? Yes | No  
If yes: To whom owed?
 Amount:
$
Have you been declared bankrupt in the last 10 years? Yes | No  
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:
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 is correct. Lender may keep this application whether or not it is approved. By submitting this form 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 updated credit information at Lender's request if my financial condition changes.
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