Below is our comprehensive loan application form, ready for your convenience. Click the Print button on your browser to get a hard copy of the application. After you fill out the form, mail or fax it to us using our contact information. One of our loan staff will call you and set up an appointment to finalize paperwork with a loan officer. Within 48 hours we will let you know the status of your loan.

Application for Personal Loan

Your Name   Date

Dealer   Phone

PERSONAL INFORMATION

Social Security No.   Married     Unmarried     Separated

Date of Birth   No. Of Dependents

LOAN APPLIED FOR

I hereby make application for a loan in the amount of $

I wish to pay the loan off in the number of months indicated

The Loan will be used for the following purposes

Collateral (Describe)

ADDRESS INFORMATION

I Presently       Own       Rent     Landlord or Mortgagee

Present Address   How Long?

Mailing Address (if different)   How Long?

Previous Address   How Long?

Mobile Home will be located

Amount of Rent or Payment $   Date Bought

Cost, if Homeowner $   Present Value of Home  $

Balance Due on Home; $   To

INCOME INFORMATION

If applicant is self employed or has a business enterprise, attach current Balance Sheet and profit and Loss Statement. You do not have to list income from alimony, child support or maintenance payments although you may do so if you wish to have it considered as a basis for repaying this obligation.

Your Employer   Phone

    Salary $   Occupation   How Long?

Former Employer   Phone

    Salary $   Occupation   How Long?

Other Income From   Amount $

Will spouse be contractually liable for loan?    Yes    No

Will income of spouse be basis for repayment?    Yes    No

Will community property be basis for repayment?    Yes    No

Will alimony, child support or maintenance be basis for repayment?    Yes    No

If the answers to the four questions above are all no, you are not required to complete the spouse information section or list the debts of your spouse in the debts outstanding section.

SPOUSE'S INFORMATION

Spouse's Name   Social Security No.

Spouse's Employer   Phone

    Salary $   Occupation   How Long?

Other Income From   Amount $

DEBTS OUTSTANDING

Debts: List all fixed obligations, Installment Accounts, Debts to Banks and Finance Companies, Alimony, Child Support or Maintenance Payments.

To Whom Indebted	Address	Name in which debt carried	Article	Balance	Amount of payments
Auto Lien Holder		Year and Make
Auto Lien Holder		Year and Make

BANK REFERENCES	PAID CREDIT REFERENCES
Checking Account No.	Name  City
Savings Account No.	Name  City
Loan No.	Name  City
Other	Name  City

USE THIS SECTION FOR PROPERTY IMPROVEMENT CREDIT ONLY

Describe Each Improvement Planned		Name & Address of Contractor/Dealer	Estimated Cost
1.			$
2.			$

Address of property to be improved

Do you own property to be improved?    Yes    No

Date Purchased   Price Paid $   Date of Mortgage

If this is a Residential Structure, has it been completed or occupied for 90 days or longer?    Yes    No

NOTICE TO APPLICANT -- READ CAREFULLY BEFORE SIGNING

THE SELECTION OF A CONTRACTOR OR DEALER, ACCEPTANCE OF MATERIALS USED, AND WORK PERFORMED IS THE APPLICANT'S RESPONSIBILITY. THE BANK DOES NOT IN ANY MANNER ARRANGE FOR, GUARANTEE THE MATERIAL OR WORKMANSHIP, OR TO INSPECT THE WORK PERFORMED. The undersigned hereby certify that the information given in the foregoing statement is true and that no unfavorable information known to me (us) or called for herein has been omitted. The lending institution is hereby authorized to obtain such information as it may require concerning said statement which at all times shall remain the property of the lending institution.

Have you ever been adjudicated a bankrupt, made a settlement with Creditors, or if you have any suits, judgments, garnishment or other legal proceedings against you?      Yes      No
Explain:

I agree to notify the Bank of any material change in the above statement. I authorize the Bank to obtain such information as the Bank may require concerning the statements made in this application and agree that the application shall remain the Bank's property whether or not the loan is granted. I, the above named applicant, hereby declare the foregoing statement is true in every respect. In making this application, I understand that an investigation may be made whereby that information may be obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry may include information as to my character, general reputation, personal characteristics and mode of living. I further understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

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