Consumer Loan Application

* - Indicates required fields

Are you applying as an individual or with a co-applicant? * Individual Co-Applicant

Is this a personal or auto loan? * Personal Auto

Vehicle Loan Information

Auto Purchase Type *

Vehicle New or Used * New Used

Year *

Make *

Model *

Mileage *

VIN or Serial Number *

Insurance Company *

Insurance Company Phone Number *

Social Security Number *

Primary Phone Number *

How would you prefer to be contacted? * Home Work Email Other

Other Contact Preference *

Driver's License Number *

Date of Expiration *

Housing Status * Own Rent Other

Estimated Property Value *

Mortgage Balance *

Explain your housing status *

Monthly Mortgage or Rent Payment *

Applicant Employment * Employed Not Employed

Current Employer

Employment Start Date *

Position or Title *

Gross Monthly Income *

Name of Employer *

Employer's Phone Number *

Employer's Address *

City *

State *

Zip Code *

Have you worked here for more than three years? (No if unemployed) * Yes No

Previous Employer (if less than three years at current)

Employment Start Date *

Position or Title *

Gross Monthly Income *

Name of Employer *

Employer's Phone Number *

Employer's Address *

City *

State *

Zip Code *

Number of Dependents

Other Monthly Income Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.

Do you intend to rely on the co-applicant's earnings to qualify for this loan? * Yes No

Co-Applicant

First Name *

Middle Initial

Last Name *

Suffix

Social Security Number *

Birth Date *

Mother's Maiden Name *

Driver's License

Driver's License Number *

State Issued *

Date of Expiration *

Contact Information

Primary Phone Number *

Work Phone Number *

Email Address

How would you prefer to be contacted? * Home Work Email Other

Housing Information

Current Address

Address *

City *

State *

Zip Code *

Previous Address

Address

City *

State *

Zip Code *

Housing Status * Own Rent Other

Monthly Mortgage or Rent Payment *

Employment

Co-Applicant Employment * Employed Not Employed

Have you worked here for more than three years? (No if unemployed) * Yes No

Income Information

Number of Dependents *

Other Monthly Income Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.

Do you intend to rely on the co-applicant's earnings to qualify for this loan? * Yes No

If yes, your spouse also may be required to sign the promissory note.

Have you or your co-applicant ever declared bankruptcy? * Yes No

Have you or your co-applicant ever had a judgement? * Yes No

Have you or your co-applicant ever had a repossession or foreclosure? * Yes No

If yes to any of the above, please explain.

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your Bank Name checking or savings account? * Yes No

Automatically transferred funds will be applied as my monthly payment on each monthly due date so long as there are adequate funds on deposit or there is available credit in my account, until the loan is paid or the Bank receives written notice to cancel. I understand the Bank reserves the right to terminate the automatic repayment plan without notice.

Account Number *

Initial your request *

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Bank Name to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Bank Name to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature *

Co-Applicant's Signature *