Resources

Consumer Loan Application

Account Requested Individual Joint
Purpose
Amount of Loan Requested
Payment Date Requested / /
Referred By

Please tell us about yourself

Name
Mother's Maiden Name
Home Address Yrs/Mos
Mailing Address (If different then actual address)
City
State
Zip Code
DOB
Social Security Number
Home Phone Number
Cell Phone Number
Name as it appears on Driver's License
Driver's License Number
Issue Date / /
Expiration Date / /
E-Mail Address
Applicant's Previous Home Address Yrs/Mos

Please tell us about the co-applicant
(if applicable)

Name
Mother's Maiden Name
Home Address Yrs/Mos
Mailing Address (If different then actual address)
City
State
Zip Code
DOB
Social Security Number
Home Phone Number
Cell Phone Number
Name as it appears on Driver's License
Driver's License Number
Issue Date / /
Expiration Date / /
E-Mail Address

About Your Job

Business Name or Employer
Self Employed (add. Info. Req.)
Business Address Number and Street Yrs/Mos
City
State
Zip Code
Business Phone
Position
Gross Mo.Income $
Previous Employer Yrs/Mos

About The Co-Applicant's Job

Business Name or Employer
Self Employed (add. Info. Req.)
Business Address Number and Street Yrs/Mos
City
State
Zip Code
Business Phone
Position
Gross Mo.Income $
Previous Employer Yrs/Mos

Additional Income

You need not disclose alimony, child support or separate maintenance Income unless you want us to consider it for purposes of this application. This includes both Applicant and Co-Applicant information.

Annual Interest & Dividend Income $
Mo. child support/Sep. Maint. $
Other Monthly Household Income $
Desc. Sources of Other Household Income.

Marital Status

Do not complete if this is an Application for individual unsecured credit.

Applicant Married
Separated
Unmarried
Co-Applicant Married
Separated
Unmarried

About Your Existing Loans and Accounts

Home Rent Home
Own Home in the following name(s):
Monthly Rent or Payment
Purchase Price
Original Loan Amount
Balance Owing
Present Value
Date Purchased / /
Name of Mortgage Holder or Landlord
Address of Mortgage Holder or Landlord
Name of Bank
Checking Account No.
Savings Account No
Have you ever had a judgment filed against you or declared bankruptcy? No Yes
Date:
Details:

Assets

Cash in banks
Stocks or Bonds
Automobiles
Real Estate
Life Ins. (face value) $
Retirement Funds, IRA's
Other Assets
Total Assets

Obligations

DescriptionAmount OwedMonthly Payment
Total Obligations

Net Worth

Net Worth

Nearest relative not living with you

Name
Address
Phone Number
Relationship

Agreement

I/We represent that this application is complete and accurate and fully reflects my/our financial condition on the date shown below. I/We authorize Lender to obtain a credit report and any other information it deems necessary about my/our credit worthiness. I/We agree to notify Lender immediately, in writing, of any adverse change in my/our financial condition. I/We understand that Lender will retain this Application whether or not it is approved.

IF this loan request is for Home Improvement Expenses, complete the following. OTHERWISE, IGNORE

Information for Government Monitoring Purposes

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.

Borrower

I do not wish to furnish this information
Sex Male
Female
Ethnicity Hispanic or Latino
Not Hispanic or Latino
Race White
Black
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander

Co-Borrower

I do not wish to furnish this information
Sex Male
Female
Ethnicity Hispanic or Latino
Not Hispanic or Latino
Race White
Black
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
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