Personal / Vehicle Credit Application

Please Note: This is not an online form. Once you type in the information,
please print out and fax or bring in to the nearest location.

Please read following directions before completing this application, and select the appropriate loan type.

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

   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 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: Jr. Sr. N/A

Birth date:

Social Security #:

Driver´s License #:

Telephone:

Email Address:

Present Street Address:

City:

State:

Zip:

Years in Residence:

Previous Street Address:

City:

State:

Zip:

Years in Residence:

Co-Applicant Information

Last Name:

First Name:

Middle Name:

Suffix: Jr. Sr. N/A

Birth date:

Social Security #:

Driver´s License #:

Telephone:

Email Address:

Present Street Address:

City:

State:

Zip:

Years in Residence:

Previous Street Address:

City:

State:

Zip:

Years in Residence:

Applicant

Number of Dependents:

Ages of Dependents:

Housing: Own
Rent

Rent/Mortgage per Month:

Mortgage Holder/Landlord:

Address:

City:

State:

Zip:

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:

Loan Information

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

What is this loan for? Automobile
Boat
Truck
Camper
Other:

New or Used? 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 Seller´s Name:

Dealer or Seller´s Address:

City:

State:

Zip:

Insurance Agent:

Insurance Agent Address:

City:

State:

Zip:

Insurance Agent Telephone:

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: Alimony

  Weekly
Monthly

  Support

  Weekly
Monthly

  Maintenance

  Weekly
Monthly

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.

Creditor #1

Original Amount

Balance Due

Monthly Payment

Creditor #2

Original Amount

Balance Due

Monthly Payment

Creditor #3

Original Amount

Balance Due

Monthly Payment

Creditor #4

Original Amount

Balance Due

Monthly Payment

Creditor #5

Original Amount

Balance Due

Monthly Payment

Creditor #6

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.

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 Commission:

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: Alimony

  Weekly
Monthly

  Support

  Weekly
Monthly

  Maintenance

  Weekly
Monthly

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.

Creditor #1

Original Amount

Balance Due

Monthly Payment

Creditor #2

Original Amount

Balance Due

Monthly Payment

Creditor #3

Original Amount

Balance Due

Monthly Payment

Creditor #4

Original Amount

Balance Due

Monthly Payment

Creditor #5

Original Amount

Balance Due

Monthly Payment

Creditor #6

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.

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 judgments 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.

Print this form and bring it to any of our locations so we can get your personal loan process started!