CONFIDENTIAL LOAN APPLICATION IMPORTANT: Please read these directions before completing this Application and check (√) the appropriate box below. if you are applying for individual credit 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 request; complete only the Applicant sections. if you are applying for joint credit with another person, complete all sections. if you are applying for individual credit, 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. LOAN REQUEST DETAILS Amount Requested: Term Requested: Approximated Payment: Loan Purpose: Collateral: For the purpose of obtaining loans with you and otherwise procuring credit from you, from time to time, I furnish you with the foregoing statement and information, which fully and truly sets forth my financial condition on the date first above mentioned, which statement you can consider as continuing to be full and accurate, unless notice in writing of change is given by me to you. I agree that this application shall remain your property whether or not the loan is granted. I further authorize you to make any verification of the above information you deem necessary in order to obtain this loan. Applicant’s Signature Date Co-Applicant’s Signature Date We intend to apply for joint credit (please initial) Applicant Co-Applicant APPLICANT CO-APPLICANT Full Name Full Name Street Address Street Address City/State/Zip City/State/Zip County County Since Own Rent Since Own Rent Previous Address (if less than 5 years at present) Previous Address (if less than 5 years at present) City/State/Zip City/State/Zip How Long Own Rent How Long Own Rent Social Security # Date of Birth Social Security # Date of Birth Phone: Residence/Cell Work Phone: Residence/Cell Work Employer Employer Address Address Position/Title Since Position/Title Since Previous Employer Previous Employer Position/Title How Long Position/Title How Long Dependents (include self) Dependents (include self) Name of Current Bank or Credit Union Name of Current Bank or Credit Union
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CONFIDENTIAL
LOAN APPLICATION
IMPORTANT: Please read these directions before completing this Application and check (√) the appropriate box below. if you are applying for individual credit 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 request; complete only the Applicant sections. if you are applying for joint credit with another person, complete all sections. if you are applying for individual credit, 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.
LOAN REQUEST DETAILS Amount Requested: Term Requested: Approximated Payment:
Loan Purpose:
Collateral:
For the purpose of obtaining loans with you and otherwise procuring credit from you, from time to time, I furnish you with the foregoing statement and information, which fully and truly sets forth my financial condition on the date first above mentioned, which statement you can consider as continuing to be full and accurate, unless notice in writing of change is given by me to you. I agree that this application shall remain your property whether or not the loan is granted. I further authorize you to make any verification of the above information you deem necessary in order to obtain this loan.
Applicant’s Signature Date Co-Applicant’s Signature Date
We intend to apply for joint credit (please initial) Applicant Co-Applicant
APPLICANT CO-APPLICANT Full Name Full Name
Street Address Street Address
City/State/Zip City/State/Zip
County County
Since Own Rent Since Own Rent
Previous Address (if less than 5 years at present)
Previous Address (if less than 5 years at present)
City/State/Zip City/State/Zip
How Long Own Rent How Long Own Rent
Social Security # Date of Birth Social Security # Date of Birth
Phone: Residence/Cell Work Phone: Residence/Cell Work
Employer Employer
Address Address
Position/Title Since Position/Title Since
Previous Employer Previous Employer
Position/Title How Long Position/Title How Long
Dependents (include self) Dependents (include self)
Name of Current Bank or Credit Union
Name of Current Bank or Credit Union
CONFIDENTIAL
ASSETS LIABILITIES Cash/Bank Accounts Installment Loans, Credit Lines, Notes (Schedule) Securities Credit Cards, Accounts, Support (Schedule) Real Estate (Schedule ) Mortgages, Real Estate Loans (Schedule) Profit Sharing, Pension, Retirement, IRA Taxes Due Other Assets & Personal Property (Describe) Other Liabilities (Describe) Total Total (Total Assets Less Total Liabilities) Net Worth
* ANNUAL INCOME APPLICANT CO-APPLICANT PLEASE ANSWER EACH QUESTION (Yes / No) APP. CO-APP Salary Are you a Co-Maker, Endorser or Guarantor of any other
person’s debt?
Bonuses/Commissions Dividends/Interest
Are you a defendant in any suit or legal action?
Other (List) Have you ever gone through bankruptcy or had a
judgment against you?
Total * Income from alimony, child support, or maintenance payments need not be entered unless you want it considered as a base for repayment
REAL ESTATE OWNED
Property Description Name of Creditor Year Aquired
Purchase Price
Mortgage Balance
Date of Maturity Repayment Terms Current Market
Vaue per
per
per
Total Total
INSTALLMENT LOANS & NOTES
Name of Creditor Collateral Description Date of Maturity Repayment Terms Balance Due
per
per
per
per
Total
CREDIT CARDS, ALIMONY, ETC. Name of Company Repayment Terms Balance Due
per
per
per
per
Total
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