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Personal / Vehicle Credit Application

Please read following directions before completing this application, and choose the appropriate circle.

Requested Loan Amount (Note: $2,000 Minimum):

 If you are applying for individual credit in your own name and are relying on you own income or assets and not the income or assets of another person as the basis for this repayment of the credit requested, complete only APPLICANT INFORMATION.    If you are applying for joint credit with another person and are relying on the income or assets of another person as the basis for repayment of the credit requested, complete CO-APPLICANT INFORMATION as well.

Applicant Information

Last Name:     First Name:   
Middle Name:  Suffix:

Birthdate:     Social Security #:    

Driverīs License #: 

Telephone:    Email Address:  

Present Street Address: 
City:     State:     Zip:    

Number of Years in Residence:    

Previous Street Address:    
City:     State:     Zip: 

Number of Years in Residence: 


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Co-Applicant Information

Last Name:     First Name:   
Middle Name:  Suffix:

Birthdate:     Social Security #:    

Driverīs License #: 

Telephone:    Email Address: 

Present Street Address: 
City:     State:     Zip:    

Number of Years in Residence:    

Previous Street Address:    
City:     State:     Zip: 

Number of Years in Residence: 

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Applicant

Number of Dependents:     Ages of  Dependents: 

Housing : Own    Rent     Rent/Mortgage per Month: 

Name of Mortgage Holder/Landlord: 

Mortgage Holder/Landlord Address: 
City:     State:     Zip: 

Original Amount of Mortgage:     Present Balance:     
Present Home Value: 

Checking Account #:     Institution or Branch: 

Savings Account #:       Institution or Branch: 

Name of Nearest Relative (Not living with you): 

Relative's Street Address:    
City:     State:     Zip: 

Relationship:     Phone Number: 

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Loan Information

Please check appropriate box(es) and give information requested.

What is this loan for?

  Automobile
  Boat
  Truck
  Camper
  Other 

  New     Used    

Mileage (if Used):

Vehicle Year:    Vehicle Make: 
Vehicle Model (If truck give Gross Vehicle Weight.  If Boat give type and length):
Number of Cylinders or Number of Engines: 
Serial or VIN Number: 

Equipped With: Radio                   Automatic Trans            Power Steering
                        Tinted Glass         4 Speed Trans             Power Brakes
                        Power Windows      Power Seats               Air Conditioning
                        High Performance Engine (Disp in CU:     HP:   )

Cash Price:     Cash Down Payment:    
Trade in Allowance:     Amount to be Financed: 

Dealer or Sellerīs Name: 
Dealer or Sellerīs Address: 
City:    State:     Zip: 

Insurance Agent: 

Insurance Agent Address: 
City:      State:     Zip: 

Insurance Agent Telephone: 

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Applicant

Present Employer:    
Work Telephone:     Position or Title: 

Type of Work:

Work Street Address: 
City:     State:     Zip: 

Years Employed with this company: 

Name of Supervisor:    
Annual Gross Salary: 

Previous Employer:    
Years Employed with this company: 

Previous Employer Street Address:   
City:     State:     Zip: 

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.

Other Income Amount:     Weekly     Monthly     Yearly

Source of Other Income:

Do you presently pay:

Type

Amount

Weekly Monthly
  Alimony  
  Support  
  Maintenance  

List all debts to banks, loan or finance companies, charge accounts, and installment purchases.  Include debts on which applicant is a co-maker, endorser, or guarantor. 

Name and Address of Creditor

Original Amount

Balance Due

Monthly Payment

       
       
       
       
       
       

Automobile Insurance is required for the full term of the contract, at your expense against the hazards of fire, theft and accidental physical damage (Including collision).  The policy is to note the bank's interest as a loss payee.  You may choose the person through whom any insurance is obtained. The bank's interest as a loss payee is required on the policy.

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Co-Applicant

Present Employer:    
Work Telephone:     Position or Title: 

Type of Work:

Work Street Address: 
City:     State:     Zip: 

Years Employed with this company: 

Name of Supervisor:    
Present Net Salary or Commision: 

Relationship to Applicant: 

Number of Dependents:     Ages of  Dependents: 

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.

Other Income Amount:     Weekly     Monthly     Yearly

Source of Other Income:

Do you presently pay:

Type

Amount

Weekly Monthly
  Alimony  
  Support  
  Maintenance       

List all debts to banks, loan or finance companies, charge accounts, and installment purchases.  Include debts on which co-applicant is a co-maker, endorser, or guarantor. 

Name and Address of Creditor

Original Amount

Balance Due

Monthly Payment

       
       
       
       
       
       

Automobile Insurance is required for the full term of the contract, at your expense against the hazards of fire, theft and accidental physical damage (Including collision).  The policy is to note the bank's interest as a loss payee.  You may choose the person through whom any insurance is obtained. The bank's interest as a loss payee is required on the policy.

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General Information

If you or a joint applicant or other party answers "yes" to any of the following questions, please explain in the space provided.

Are you a guarantor or co-maker of any leases, contract or debts? (Other than housing expenses already provided.)
Applicant:      Yes    No           Joint Applicant: Yes    No

 

Are there any suits or judgements against you? (Include amount)
Applicant:      Yes    No           Joint Applicant: Yes    No

 

Have you been declared bankrupt in the last 10 years?                      
Applicant:  Yes     No           Joint Applicant:  Yes   No

 

I certify that everything I have stated in this application and on any attachments is correct.  You may keep this application whether or not it is approved.  By typing and submitting this form, I authorize you to check my credit and employment history, to have a consumer credit report prepared on me for the purpose of evaluating this application for credit, and to answer questions others may ask you about my credit record with you.  I understand that I must update this credit information at your request and if my financial condition changes.

Applicant Signature:              Date: 

Joint Applicant Signature:     Date: 

Please bring this loan application to the location which is most convenient to you.
We will need your signature and identification to be provided at any one of our locations for the new loan documents.
(It can be provided at any one of our convenient locations).

Upon receiving your application, we will attempt to contact you within 24 hours and notify of any additional information needed for this loan. If you should not hear from us, please contact us at 940-686-7000.  

Thank you for considering PointBank for your financing needs!

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