Personal Loan Application – Fill Out and Use This PDF

PERSONAL LOAN APPLICATION

[SEE REVERSE SIDE FOR IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT]

IMPORTANT: Read these Directions before completing this Application. Check the Appropriate Box.

If you are applying for individual credit or an individual account, in your own name, and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A-D. If the requested credit or account is to be secured, also complete the first part of Section F.

If you are applying for individual credit or an individual account, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all Sections to the extent possible, providing information in Section E about the person on whose alimony, support, or maintenance payments or income or assets you are relying.

SECTION A - APPLICANT

SECTION B - INCOME AND EMPLOYMENT

Is any income listed in this Section likely to be reduced in the next two years or before the credit requested is paid off?

SECTION C - ASSETS

SECTION D - LIABILITIES AND INDEBTEDNESS

List below all indebtedness to banks, credit unions, stores, finance companies, individuals and other creditors, including obligations to pay alimony, child support, separate maintenance, rent, mortgages, etc.

SECTION E - JOINT APPLICANT, USER OR OTHER PARTY (Use separate sheets, if needed.)

If this Section of Application is completed, the indebtedness of Co-Applicant/Guarantor/Endorser must be shown under the "Liabilities and Indebtedness" Section above. (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)

Is any income listed in this Section likely to be reduced in the next two years or before the credit requested is paid off?

No Yes (Explain in detail, use separate sheet if needed):

SECTION F - MARITAL STATUS

SIGNATURES

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not loan is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

CONSUMER(S) ADDRESS

In this disclosure, the terms "you" and "your" refer to the Consumer(s) named above. The terms "we," "us" and "our" refer to the Financial Institution.

PURCHASE OF INSURANCE OR AN ANNUITY FROM US IS NOT REQUIRED PURCHASE OF INSURANCE OR AN ANNUITY FROM OTHERS IS NOT PROHIBITED

In no way will our decision to extend credit to you be based or conditioned upon whether or not you purchase an insurance product or annuity from us or any affiliate of ours; nor will we prohibit you or ask you not to obtain an insurance product or annuity from an unaffiliated entity.

Consumer Acknowledgment

By signing below you acknowledge receiving a copy of this written disclosure and (except for transactions conducted by mail) that the disclosures were also orally given to you by the Financial Institution.

Dated:.

(If you have received this disclosure in the mail, please return a signed copy to the Financial Institution.)

Financial Institution Certification

(Check if applicable). The Consumer's application for credit was taken by telephone. The undersigned on behalf of the Financial Institution certifies giving these disclosures orally to the Consumer(s) at the time of application and that an oral acknowledgment of receipt of the disclosures was obtained from the Consumer(s). These disclosures were mailed to the Consumer(s) at the address noted above within 3 business days beginning the first business day after the application was taken, as permitted by federal regulation.

Dated:By:

STATEMENT OF INTENT TO APPLY FOR INDIVIDUAL OR JOINT CREDIT

APPLICANT(S) ADDRESS

Regarding the application for credit in the amount of _________________________________ made on ______________________________ (date)

with the above Financial Institution:

Check Applicable Box

I am applying for individual credit in my own name, and I am relying on my own income or assets and not the income or assets of another person as the basis for repayment of the credit requested.

I am applying for individual credit, but I am relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested.

We intend to apply for joint credit.

SIGNATURE(S)