Loan Application

Loan Type*
Loan Request For*
Preferred Bank Location*  
Amount Requested *
# of Payments *
Requested Due Date *
Purpose of Loan Proceeds *


Residence Information

(if at above less then 2 years)
Residential Ownership Status:*
Years at Current Address*: Years at Previous Address*:

Employment Information

(if at above less than 2 years)

Are you Self-Employed?*
If Yes federal tax returns will be required for the previous 2 years.
(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)
Support/Maint/Alimony: $ /month


Interest Only payments?
Have any applicants ever filed for bankruptcy?*
Have any applicants even had a repossession?*
Do any applicants have any unsatisfied judgments or liens?*

Information for government monitoring purposes

Applicant's Martial Status:*
(1) Are any of the proceeds of this loan being used to purchase or refinance a dwelling that is or will become your primary residence?*
(2) Are any of the proceeds of this loan being used for home improvements on ANY residence and/or the property on which it is located?*

I have read and understand the Privacy and Security policies.