Personal Loan Application – Fill Out and Use This PDF

We intend to apply for joint credit.

Applicant _________________________________________ Co-Applicant ________________________________________________

NAME (Please print full name)

IHOME PHONE

ICELL PHONE

AMOUNT OF LOAN

IREQUESTED MOS. TO PAY

PRESENT STREET

HOW LONG

AT THIS ADDRESS

PURPOSE OF LOAN

CITY, STATE, AND ZIP

IE-MAIL ADDRESS:

COLLATERAL OFFERED AND HOW OWNED

IMMEDIATE PREVIOUS ADDRESS

HOW LONG AT THIS ADDRESS

Have you ever applied to us for a loan?

CITY AND STATE

ZIP

□ Yes

□ No

If Yes, When?

SOCIAL SECURITY NUMBER

IDRIVERS 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?

I□ YES

□ NO

MY PRINCIPAL FINANCIAL INSTITUTION IS:

Services

□ Checking Account

□ Savings Account

□ Safe Deposit

□ Loan

I

OTHER

FINANCIAL INSTITUTIONS USED

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:

I

HOW LONG RECEIVED

I

HOW OFTEN

FROM WHOM

□ Written Agreement □ Court Decree □ Other

SECTION C – ASSETS

AUTOS ( Make, Model, Year)

VALUE

I

VALUE

I

VALUE

TOTAL VALUE

REAL ESTATE (Location)

DATE OCCUPIED

VALUE

I

OTHER ASSETS (describe)

ESTIMATED VALUE

OTHER ASSETS (describe)

AUTO INSURANCE AGENTS: (Name and Address)

TOTAL

ASSETS

CREDITOR

TYPE OF DEBT OR

ORIGINAL

PRESENT

COLLATERAL

MONTHLY

ACCOUNT NUMBER

DEBT

AMOUNT OWED

PAYMENT

LANDLORD OR MORTGAGE HOLDER

□ Rent Payment

(omit rent)

(omit rent)

□ 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

%

ILIABILITIES:

%

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

APPLICANT’S SIGNATURE

DATE

CO-APPLICANT/GUARANTOR/ENDORSER SIGNATURE (Where Applicable)

DATE

X____________________________________________________

______________

X_____________________________________________________________________

____________