Consumer Loan Application

CONSUMER LOAN APPLICATION L&C1

IMPORTANT: Read these Directions before completing this Application. Check Appropriate Box:

If you are applying for individual credit in your own name, are not married, and are not relying on alimony, child support, or separate maintenance payments or on the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A and D. If the requested credit is to be secured, also complete Section E.

In all other situations, complete all Sections except E, providing information in B about your spouse, a joint applicant or user, or the person on whose alimony, support or maintenance payments or income or assets you are relying. If the requested credit is to be secured, also complete Section E.

YOU MAY APPLY FOR A SEPARATE ACCOUNT, EVEN IF YOU ARE MARRIED.

Amount Requested: Payment Date Desired:

Proceeds of Credit to Be Used for:

SECTION A - INFORMATION REGARDING APPLICANT

Full Name (Last, First, Middle): Date of Birth: Telephone:

Address: City/St/Zip:

Years there: Social Security No.: Driver's License No.:

Previous Address: Years there:

Present Employer: How Long?: Phone:

Address: Your Position: Supervisor:

Previous Employer: Years there: Phone:

Address: Your Position: Supervisor:

Present Net Salary or Commission: per

No. Dependents: Ages:

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 Oral Understanding Written Agreement

Other Income: per Sources of Other Income:

Is any income listed in this section likely to be reduced in the next two years or before the credit requested is paid off? Yes No

Have you ever received credit from us? When?

Your Bank: Branch: Account No:

Nearest relative not living with you: Relationship:

Address: Telephone:

SECTION B - INFORMATION REGARDING SPOUSE, JOINT APPLICANT, USER, OR OTHER PARTY

(Use separate sheets if necessary.)

Full Name (Last, First, Middle): Date of Birth: Telephone:

Address: City/St/Zip:

Years there: Social Security No.: Driver's License No.:

Previous Address: How Long?: Phone:

Present Employer: How Long?: Phone:

Address: Your Position: Supervisor:

Previous Employer: How Long?: Phone:

Address: Your Position: Supervisor:

Present Net Salary or Commission: per

No. Dependents: Ages:

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 Oral Understanding Written Agreement

Other Income: per Sources of Other Income:

Is any income listed in this section likely to be reduced in the next two years or before the credit requested is paid off? Yes No

Have you ever received credit from us? When?

Your Bank: Branch: Account No:

Nearest relative not living with you: Relationship:

Address: Telephone:

SECTION C - MARITAL STATUS

Applicant: Married Separated Unmarried (includes single, divorced, and widowed.)

Other Party: Married Separated Unmarried

SECTION D - ASSET AND DEBT INFORMATION

(If Section B has been completed, this Section should be completed by giving information about both the Applicant and Spouse, Joint Applicant, User, 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.)

Assets:

Cash in Bank:

Checking Account

Savings Account

Credit Union

Stocks and Bonds

Cash Value of Life Insurance

Automobile

Furniture and Personal Property

Real Estate Owned

Vested Interest in Retirement Fund

Net Worth of Business Owned

Other Assets

Total Assets

Outstanding Debts

Creditors Name, Address and Account Number / Unpaid Balance / Monthly Payment

Automobile Loan

Real Estate Loan

TOTAL

Previous Credit References

Creditor's Name: Acct #: Date Paid:

Address: Purpose: High Balance:

Creditor's Name: Acct #: Date Paid:

Address: Purpose: High Balance:

Creditor's Name: Acct #: Date Paid:

Address: Purpose: High Balance:

Are there any judgments against you? Yes No To whom: Amt. $

Have you been declared bankruptcy in the last 14 years? Yes No Where Year

Other obligations (For example, liability to pay alimony, child support, separate maintenance. Use separate sheets if necessary.):

SECTION E - SECURED CREDIT (Complete only if credit is to be secured.)

Briefly describe the property to be given as security:

List names and addresses of all co-owners of the property:

Name Address

Name Address

Name Address

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.

SECTION E - SECURED CREDIT (Complete only if credit is to be secured.)

Briefly describe the property to be given as security:

List names and addresses of all co-owners of the property:

Name Address

Name Address

Name Address