Personal Loan Application

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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
OTHER FINANCIAL INSTITUTIONS USED
MY PRINCIPAL FINANCIAL INSTITUTION IS:
Services
Checking Account
Savings Account
Safe Deposit
Loan
presently used
No.
No.
Cert. of Deposit
SECTION B – INCOME AND EMPLOYMENT
PRESENT EMPLOYER
SALARY AND WAGES
MONTHLY INCOME
EMPLOYER ADDRESS
BUSINESS PHONE
OTHER INCOME – From Whom or Describe (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)
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:
HOW LONG RECEIVED
HOW OFTEN
FROM WHOM
Written Agreement
Court Decree
Other
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.
TYPE OF DEBT OR
ORIGINAL
PRESENT
MONTHLY
CREDITOR
COLLATERAL
ACCOUNT NUMBER
DEBT
AMOUNT OWED
PAYMENT
LANDLORD OR MORTGAGE HOLDER
(omit rent)
(omit rent)
Rent Payment
Mortgage
CREDIT CARDS
LIABILITIES
MONTHLY PAYMENTS
Totals
Have you ever been bankrupt or had any judgments or garnishments against you?
MONTHLY DEBT
ASSETS TO
NO
YES- WHEN?
TO INCOME
%
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
OTHER FINANCIAL INSTITUTIONS USED
MY PRINCIPAL FINANCIAL INSTITUTION IS:
Services
Checking Account
Savings Account
Safe Deposit
Loan
presently used
No.
No.
Cert. of Deposit
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 your credit experience with me.
APPLICANT’S SIGNATURE
DATE
CO-APPLICANT/GUARANTOR/ENDORSER SIGNATURE (Where Applicable)
DATE
X____________________________________________________
______________
X_____________________________________________________________________
____________

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