Personal Loan Application Form

PERSONAL LOAN APPLICATION

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

If you are applying for individual credit or an individual account, in your own name, and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A-D.

If you are applying for joint credit with another person or for a joint account or an account that you and another person will use, complete all Sections, providing information in Section E about the joint applicant.

We intend to apply for joint credit. Applicant Co-Applicant

If you are applying for individual credit or an individual account, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all Sections to the extent possible, providing information in Section E about the person on whose alimony, support, or maintenance payments or income or assets you are relying.

SECTION A - APPLICANT

NAME (Please print full name) HOME PHONE CELL PHONE AMOUNT OF LOAN REQUESTED MOS. TO PAY

PRESENT STREET HOW LONG AT THIS ADDRESS PURPOSE OF LOAN

CITY, STATE, AND ZIP E-MAIL ADDRESS: COLLATERAL OFFERED AND HOW OWNED

IMMEDIATE PREVIOUS ADDRESS HOW LONG AT THIS ADDRESS

CITY AND STATE ZIP Have you ever applied to us for a loan? Yes No If Yes, When?

SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER – STATE BIRTH DATE NO. OF DEPENDENTS – LIST BY AGE

NAME, ADDRESS AND RELATIONSHIP OF TWO NEAREST RELATIVES NOT LIVING WITH YOU OTHER THAN A PRESENT OR FORMER SPOUSE

ARE YOU A U. S. CITIZEN? YES NO

MY PRINCIPAL FINANCIAL INSTITUTION IS: Services presently used Checking Account Savings Account Safe Deposit Loan Cert. of Deposit

OTHER FINANCIAL INSTITUTIONS USED

SECTION B – INCOME AND EMPLOYMENT

PRESENT EMPLOYER SALARY AND WAGES MONTHLY INCOME

EMPLOYER ADDRESS BUSINESS PHONE OTHER INCOME – From Whom or Describe

POSITION OR TITLE DATE OF EMPLOY

PREVIOUS EMPLOYER AND ADDRESS

POSITION OR TITLE YEARS EMPLOYED TOTAL MONTHLY INCOME

If you have chosen to disclose income from alimony, child support or separate maintenance, is such income pursuant to: Written Agreement Court Decree Other

HOW LONG RECEIVED HOW OFTEN FROM WHOM

SECTION C – ASSETS

AUTOS (Make, Model, Year) VALUE VALUE VALUE TOTAL VALUE

REAL ESTATE (Location) DATE OCCUPIED VALUE

OTHER ASSETS (describe) ESTIMATED VALUE

OTHER ASSETS (describe)

AUTO INSURANCE AGENTS: (Name and Address) TOTAL ASSETS

SECTION D – LIABILITIES AND INDEBTEDNESS

List below all indebtedness to banks, credit unions, stores, finance companies, individuals and other creditors, including obligations to pay alimony, child support, separate maintenance, rent, mortgages, etc.

CREDITOR TYPE OF DEBT OR ACCOUNT NUMBER ORIGINAL DEBT PRESENT AMOUNT OWED

COLLATERAL MONTHLY PAYMENT

LANDLORD OR MORTGAGE HOLDER Rent Payment Mortgage

(omit rent) (omit rent)

CREDIT CARDS

Totals LIABILITIES MONTHLY PAYMENTS

Have you ever been bankrupt or had any judgments or garnishments against you? NO YES- WHEN?

MONTHLY DEBT TO INCOME % ASSETS TO LIABILITIES: %

SECTION E – JOINT APPLICANT, USER OR OTHER PARTY (Use separate sheets, if needed.)

If this Section of Application is completed, the indebtedness of Co-Applicant/Guarantor/Endorser must be shown under the “liabilities and Indebtedness” Section above. (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)

NAME AND RELATIONSHIP TO APPLICANT ADDRESS CO-APPLICANT GUARANTOR ENDORSER

EMPLOYED BY HOW LONG POSITION OR TITLE BUSINESS PHONE HOME PHONE

SOCIAL SECURITY NUMBER BIRTH DATE

MONTHLY INCOME OTHER INCOME TOTAL INCOME DRIVERS LICENSE NUMBER - STATE

NAME, ADDRESS AND RELATIONSHIP OF TWO NEAREST RELATIVES NOT LIVING WITH YOU OTHER THAN A PRESENT OR FORMER SPOUSE

ARE YOU A U.S. CITIZEN: Yes No

MY PRINCIPAL FINANCIAL INSTITUTION IS: Services presently used Checking Account Savings Account Safe Deposit Loan Cert. of Deposit

OTHER FINANCIAL INSTITUTIONS USED

SIGNATURES

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 loan is approved. You are authorized to check my credit and employment history and to answer questions about my credit experience with me.

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