Bank Loan Application Form

Bank Loan Application Form

Applicant Information

Entity Type: Individual Joint LLC Corporation Partnership Trust Other

Date of Birth:    Social Security / Tax ID:

Primary Phone:    Email:

Co‑Applicant / Co‑Signer (if applicable)

Relationship to Applicant:    Phone:

Loan Request Details

Desired Term (months):    Repayment Frequency: Monthly Bi‑Weekly Weekly

Requested Interest Rate (if applicable):    Preferred First Payment Date:

Are there existing liens on the collateral? Yes No

Employment and Income

Position/Title:    Employment Start Date:

Gross Monthly Income:    Other Monthly Income:    Total Monthly Income:

Assets and Liabilities

Provide current balances. If none, enter zero.

Credit References

Reference 1 — Name:   Account #:   Phone:

Reference 2 — Name:   Account #:   Phone:

Reference 3 — Name:   Account #:   Phone:

Declarations, Certifications and Authorizations

I certify under penalty of law that the information contained in this application and any accompanying documentation is true, complete and correct to the best of my knowledge. I understand that intentional misstatements may constitute fraud and may result in criminal or civil liability and denial of this application.

I authorize the lender and its agents to verify the accuracy of the information provided, obtain credit reports and employment and bank account verifications, and to disclose such information to credit reporting agencies, insurers, guarantors, or as required by law. This authorization remains in effect until my loan request is finally approved or denied.

I agree to notify the lender promptly of any material change in my financial condition or employment prior to loan closing. I understand that the lender may require additional documentation, and that submission of this application does not obligate the lender to extend credit or create any legal commitment.

Applicant attests that all assets listed are in the applicant's name unless otherwise noted and that the applicant is not a party to any pending bankruptcy proceeding. If the applicant is a business, the undersigned certifies authority to execute this application on behalf of the business and personally guarantees the accuracy of the information provided.

By checking the following box the applicant acknowledges and consents to the statements above and authorizes the lender to proceed with verification and credit review. Applicant consents to verification and credit inquiry

Supporting Documentation

The applicant understands that the lender will require supporting documentation, which may include recent pay stubs, tax returns, bank statements, proof of title or insurance for collateral, business financial statements, and government‑issued identification. Failure to provide requested documentation may result in denial of the application.

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