Personal or Vehicle Credit Application
Requested Loan Amount:
Please read following directions before completing this application, and choose the appropriate circle.

Individual Credit

 Check here if you are applying for individual credit. This means you are applying in your own name and are relying on your own income or assets, NOT those of another person as the basis for repayment.

Complete only the applicant information.

Joint Credit

 Check here if you are applying for joint credit. This means you are applying for credit with another person and will be relying on both your and their income or assets as the basis for repayment.

Complete both the applicant information and the co-applicant information.

Applicant Information
Last Name:     First Name:   
Middle Name: 

Birthdate:     Social Security #:    

Driver´s License #: 

Telephone:   

Applicant's email:

Present Street Address: 
City:     State:     Zip:    

Number of Years in Residence:    

Previous Street Address:    
City:     State:     Zip: 

Number of Years in Residence: 

Co-Applicant Information
Last Name:     First Name:   
Middle Name: 

Birthdate:     Social Security #:    

Driver´s License #: 

Telephone:    Email Address: 

Present Street Address: 
City:     State:     Zip:    

Number of Years in Residence:    

Previous Street Address:    
City:     State:     Zip: 

Number of Years in Residence: 

Applicant
Number of Dependants:     Ages of  Dependants: 

Housing : Own    Rent     Rent/Mortgage per Month: 

Name of Mortgage Holder/Landlord: 

Mortgae Holder/Landlord Address: 
City:     State:     Zip: 

Original Amount of Mortgage:     Present Balance:     
Present Home Value: 

Checking Account #:     Institution or Branch: 

Savings Account #:       Institution or Branch: 

Name of Nearest Relative (Not living with you): 

Relative's Street Address:    
City:     State:     Zip: 

Relationship:     Phone Number: 

Applicant's email:

Loan Information
Please check appropriate box(es) and give information requested.

  Automobile
  Boat
  Truck
  Camper
  Other 
  Personal Loan
What type of collateral is this loan for?

 New     Used    

Mileage (if Used):

Vehicle Year:    Vehicle Make: 
Vehicle Model (If truck give Gross Vehicle Weight.  If Boat give type and length):
Number of Cylinders or Number of Engines: 
Serial or VIN Number: 

Equipped With: Radio                   Automatic Trans            Power Steering
                        Tinted Glass         4 Speed Trans             Power Brakes
                        Power Windows      Power Seats               Air Conditioning
                        High Performance Engine (Disp in CU:     HP:  )

Cash Price:     Cash Down Payment:    
Trade in Allowance:     Amount to be Financed: 

Dealer or Seller´s Name: 
Dealer or Seller´s Address: 
City:    State:     Zip: 

Insurance Agent: 

Insurance Agent Address: 
City:      State:     Zip: 

Insurance Agent Telephone: 

PERSONAL CONSUMER LOANS ( if loan is not for Auto or other vehicle)

Item Description:

Estimated Value:

Applicant
Present Employer:    
Work Telephone:     Position or Title: 

Type of Work:

Work Street Address: 
City:     State:     Zip: 

Years Employed with this company: 

Name of Supervisor:    
Annual Gross Salary: 

Previous Employer:    
Years Employed with this company: 

Previous Employer Street Address:   
City:     State:     Zip: 

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.

Other Income Amount:     Weekly     Monthly     Yearly

Source of Other Income:

Do you presently pay:
Type
Amount
 Weekly Monthly
  Alimony  
  Support  
  Maintenance  

Name and Address of Creditor
Original Amount
Balance Due
Monthly Payment
       
       
       
       
       
       

Insurance is required for the full term of the contract, at your expense against the hazards of fire, theft and accidental physical damage (Including collision).  The policy is to note the bank's interest with a loss payable clause in its favor.  You may choose the agent through whom any insurance is obtained.
Co-Applicant
Present Employer:    
Work Telephone:     Position or Title: 

Type of Work:

Work Street Address: 
City:     State:     Zip: 

Years Employed with this company: 

Name of Supervisor:    
Present Net Salary and/or Commision: 

Relationship to Applicant: 

Number of Dependants:     Ages of  Dependants: 

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.

Other Income Amount:     Weekly     Monthly     Yearly

Source of Other Income:

Do you presently pay:
Type
Amount
 Weekly Monthly
  Alimony  
  Support  
 Maintenance      

List all debts to banks, loan or finance companies, charge accounts, and installment purchases.  Include debts on which applicant is a co-maker, endorser, or guarantor. 

Name and Address of Creditor
Original Amount
Balance Due
Monthly Payment
       
       
       
       
       
       

Insurance is required for the full term of the contract, at your expense against the hazards of fire, theft and accidental physical damage (Including collision).  The policy is to note the bank's interest with a loss payable clause in its favor.  You may choose the agent through whom any insurance is obtained.
General Information
If you or a joint applicant or other party answers "yes" to any of the following questions, please explain in the space provided.

Are you a guarantor or co-maker of any leases, contract or debts? 
Applicant:      Yes    No           Joint Applicant: Yes    No

 

Are there any suits or judgements against you? (Include amount)
Applicant:      Yes    No           Joint Applicant: Yes    No

 

Have you been declared bankrupt in the last 10 years?                      
Applicant:  Yes     No           Joint Applicant:  Yes   No

 

I certify that everything I have stated in this application and on any attachments is correct.  You may keep this application whether or not it is approved.  By typing and submitting this form, I authorize you to check my credit and employment history, to have a consumer credit report prepared on me for the purpose of evaluating this application for credit, and to answer questions others may ask you about my credit record with you.  I understand that I must update this credit information at your request and if my financial condition changes.

Applicant Signature:              Date: 

Joint Applicant Signature:     Date: