Consumer Loan Application
* indicates a required field
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 whose alimony, child support, or separate maintenance payments or income or assets you are relying. If the requested credit is to be secured, also complete Section E. |
If you intend to apply for joint credit, please initial here:
Applicant
Co-Applicant
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SECTION A: INFORMATION REGARDING APPLICANT |
*Name (First M. Last) |
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*Date of Birth (mm/dd/yyyy) |
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*Street Address |
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*City, State Zip |
,
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Years there: |
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Home Phone Number |
(
)
-
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*E-mail |
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Mobile Phone Number |
(
)
-
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*Social Security Number |
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Driver's License Number |
State
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Employer |
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Years there: |
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Current Work Phone Number |
(
)
-
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Job Title |
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Name of Supervisor |
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Employer's Address |
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City, State |
,
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Zip |
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Net salary or commission: |
$
per
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Number of Dependents |
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Ages of Dependents |
#1
#2
#3
#4
#5
#6
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Other income: $
per
Source(s) of other income:
SECTION B: INFORMATION REGARDING JOINT APPLICANT, USER, OR OTHER PARTY(Use separate sheets if necessary) |
Name (First M. Last) |
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Date of Birth (mm/dd/yyyy) |
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Street Address |
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City, State Zip |
,
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Years there: |
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Home Phone Number |
(
)
-
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E-mail |
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Mobile Phone Number |
(
)
-
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Social Security Number |
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Driver's License Number |
State
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Employer |
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Years there: |
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Current Work Phone Number |
(
)
-
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Job Title |
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Name of Supervisor |
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Employer's Address |
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City, State |
,
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Zip |
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Net salary or commission: |
$
per
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Number of Dependents |
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Ages of Dependents |
#1
#2
#3
#4
#5
#6
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Other income: $
per
Source(s) of other income:
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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 (Explain in detail on a separate sheet)
No |
Have you ever received credit from us? |
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When? |
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Office: |
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Checking Account No.: |
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Institution and Branch: |
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Savings Account No.: |
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Institution and Branch: |
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Name of nearest relative not living with you: |
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Telephone: |
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Relationship: |
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Address: |
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SECTION C: MARITAL STATUS |
Applicant: |
Married
Separated
Unmarried (including single, divorced, and widowed) |
Other Party: |
Married
Separated
Unmarried (including single, divorced, and widowed) |
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SECTION D: ASSET AND DEBT INFORMATION (If Section B has been completed, this Section should be completed 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 OWNED (use separate sheet if necessary.)
OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use separate sheet if necessary.)
Are you a co-maker, endorser, or guarantor on any loan or contract?
Yes If “Yes” for whom?
To whom?
No
Are there any unsatisfied judgments against you?
Yes If “Yes” to whom owed?
Amount $
No
Have you been declared bankrupt in the last 14 years?
Yes If “Yes” where?
Year
No
Other Obligations—(e.g., liability to pay alimony, child support, separate maintenance. Use separate sheet if necessary.)
SECTION E: SECURED CREDIT (Briefly describe the property to be given as security and list names and addresses of all property co-owners)
Property Description
*Everything that I have stated in this application is true and 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. False statements may result in prosecution under 18 U.S.C. 1001.
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