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Consumer Loan Application

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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
LOAN PURPOSE:
LOAN AMOUNT:
SEND THIS APPLICATION TO:

SECTION A: INFORMATION REGARDING APPLICANT
*Name (First M. Last)
*Date of Birth (mm/dd/yyyy)
*Street Address
*City, State Zip ,
Years there:
Home Phone Number ( ) -
*E-mail
Mobile Phone Number ( ) -
*Social Security Number
Driver's License Number State
Employer
Years there:
Current Work Phone Number ( ) -
Job Title
Name of Supervisor
Employer's Address
City, State ,
Zip
Net salary or commission: $ per
Number of Dependents
Ages of Dependents #1   #2
#3   #4
#5   #6

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 written agreement oral understanding
Amount $

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)
Date of Birth (mm/dd/yyyy)
Street Address
City, State Zip ,
Years there:
Home Phone Number ( ) -
E-mail
Mobile Phone Number ( ) -
Social Security Number
Driver's License Number State
Employer
Years there:
Current Work Phone Number ( ) -
Job Title
Name of Supervisor
Employer's Address
City, State ,
Zip
Net salary or commission: $ per
Number of Dependents
Ages of Dependents #1   #2
#3   #4
#5   #6

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 written agreement oral understanding
Amount $

Other income: $ per
Source(s) 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 (Explain in detail on a separate sheet)
No
Have you ever received credit from us?
When?
Office:
Checking Account No.:
Institution and Branch:
Savings Account No.:
Institution and Branch:
Name of nearest relative not living with you:
Telephone:
Relationship:
Address:

SECTION C: MARITAL STATUS
Applicant: Married Separated
Unmarried (including single, divorced, and widowed)
Other Party: Married Separated
Unmarried (including single, divorced, and widowed)

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.)
Description of Assets Value Subject to Debt? Name(s) of Owner(s)
Cash $ Yes
No
Automobile
(Make, Model, Year)
Yes
No
Cash Value of Life Insurance
(Issuer, Face Value)
Yes
No
Real Estate
(Location, Date Acquired)
Yes
No
Marketable Securities
(Issues, Type, No of Shares
Yes
No
Other
(list)
Yes
No
Total Assets $ Yes
No
OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use separate sheet if necessary.)
Creditor Type of Debt or Acct No.  Name in
Which Acct. Carried
Original Debt  Present Balance Monthly Payments Past Due 
(Landlord or Mortgage Holder) Payment   (Omit rent) (Omit rent)    
1. Rent
Mortgage
Yes
No
2. Yes
No
3. Yes
No
4. Yes
No
5. Yes
No
Total Debts   $ $ $  
(Credit References)   Date Paid
1. $
2. $

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
Co-owner Name Co-owner Address
Co-owner Name Co-owner Address

*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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