| General Information | ||
Will there be a co-applicant on this application:  Yes No |
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| If Joint Application Please Initial |
Primary Applicant I am applying for joint credit |
Joint Applicant I am applying for joint credit |
| Marital Status: Complete marital status if this loan is for: a. Joint or secured credit, or b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI) Unmarried
Married
Separated This loan is not for joint or secured credit and I do not live in the states listed above. |
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| Type of Loan Requested: | ||
| Loan Amount Requested: | Loan Term Requested: | |
| Primary Applicant: | Joint Applicant: |
| Full Name: | Full Name: |
| Social Security Number (TIN): | Social Security Number (TIN): |
| Date of Birth: | Date of Birth: |
| Home Phone Number: | Home Phone Number: |
| Work Phone Number: | Work Phone Number: |
| Current Address: | Current Address: |
| City, State, Zip: | City, State, Zip: |
| Time at Current Residence: | Time at Current Residence: |
| Residence Type: Rent Own Other: |
Residence Type: Rent Own Other: |
| Previous Address: | Previous Address: |
| City, State, Zip: | City, State, Zip: |
| Time at Previous Residence: | Time at Previous Residence: |
| Residence Type: Rent Own Other: |
Residence Type: Rent Own Other: |
| Present Employer: | Present Employer: |
| Employment
Status: Full Time Part Time Retired
| Employment
Status: Full Time Part Time Retired
|
| Job Title: | Job Title: |
| Job Start Date: | Job Start Date: |
| Gross Salary:
per Year Month Hour |
Gross Salary:
per Year Month Hour |
| Other Income:
per Year Month Hour |
Other Income:
per Year Month Hour |
| Other Income Source: | Other Income Source: |
| 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. | |
| Previous Employer: | Previous Employer: |
| Employment
Status: Full Time Part Time Retired
| Employment
Status: Full Time Part Time Retired
|
| Job Title: | Job Title: |
| Job Start/End Date: | Job Start/End Date: |
| Gross Salary:
per Year Month Hour |
Gross Salary:
per Year Month Hour |
| Have You Ever Filed For Bankruptcy? Yes No |
Have You Ever Filed For Bankruptcy? Yes No |
| Do You Have Unsatisfied Judgements? Yes No |
Do You Have Unsatisfied Judgements? Yes No |
| Are You A Co-signer On Any Other Loan? Yes No |
Are You A Co-signer On Any Other Loan? Yes No |
| Nearest Relative Not Living With You | |
| Name: | Name: |
| Phone Number: | Phone Number: |
| Address: | Address: |
| City, State, Zip: | City, State, Zip: |
| Debts/Monthly Payments: | |||
| List all debts (for example, mortgage/rent, auto loans, credit cards, second mortgage, alimony, child support, etc.) Please use a separate line for each credit card and auto loan. |
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| Institution Name | Monthly Payment | Institution Name | Monthly Payment |
| Additional Information | |||
| How would you prefer to be contacted?Home Phone Work Phone Other Phone (please specify) | |||
| Signatures | |||
| Income verification is required; other information may be required. I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.) |
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| Primary Applicant Signature: | Date: | ||
| Joint Applicant Signature: | Date: | ||