Mutual Savings Association, FSA

Member FIDC | Equal Housing Lender
Privacy Statement

Consumer Loan Application
Submitter Information (Required)
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Resolve the errors marked in red before submitting again.
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Fields marked with * are mandatory.

Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Security Notice:
You should ONLY fill out this form on-line if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now. This form is NOT cached (saved in your computer's memory) when you QUIT your browser.

This loan application is for personal loans only and is NOT intended for commercial use. A valid social security number is required to apply. Please review and gather the information you will need before completing this form.

Personal Loan Request
Amount Requested:
Type of Application:
Purpose of Loan
Applicant
First NameMiddle InitialLast Name
Date of BirthSocial Security No.No. of Dependents
Driver's License No.Driver's License StateYour E-mail Address
Home PhoneBest Time To CallWork Phone
Marital Status
Have any applicants had a repossession?
Are there any unsatisfied Judgments against you?
Have you been declared bankrupt in the last 7 years?
Residence
Your Primary Residence:
Present Address
Years At Present AddressYour Monthly Rent or Mortgage Payment
Years At Previous AddressYour Previous Address
Home Information
Collateral Property Address (If different from above)Date Purchased
Current Mortgage HolderMortgage Holder Phone
Purchase PriceMarket ValueMortgage Balance
Employment
Your Present EmployerPhone
Address Information
Gross Monthly SalaryYour PositionYears There

You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.

Other Monthly IncomeSource of Other Income
Previous Employer (if less than 3 years at current employer)Years at Previous Employer
Address Information
Additional Information
Your Checking Account NumberInstitution Name
Your Savings Account Number.Institution Name
Name of CreditorApprox. BalanceMonthly PaymentCollateral, if any
Total Amount of Other Monthly Payments not listed above:
Co-Applicant
First NameMiddle InitialLast Name
Date of BirthSocial Security No.No. of Dependents
Driver's License NoDriver's License StateYour E-mail Address
Home PhoneBest Time To CallWork Phone
Co-Applicant Residence
Your Primary Residence:
Present Address
Years At Present AddressYour Monthly Rent or Mortgage Payment
Years At Previous AddressYour Previous Address
Co-Applicant Home Information
Collateral Property Address (If different from above)Date Purchased
Current Mortgage HolderMortgage Holder Phone
Purchase PriceMarket ValueMortgage Balance
Co-Applicant Employment
Your Present EmployerPhone
Address Information
Gross Monthly SalaryYour PositionYears There

You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.

Other Monthly IncomeSource of Other Income
Previous Employer (if less than 3 years at current employer)Years at Previous Employer
Address Information
Co-Applicant Additional Information
Your Checking Account NumberInstitution Name
Your Savings Account Number.Institution Name
Name of CreditorApprox. BalanceMonthly PaymentCollateral, if any
Total Amount of Other Monthly Payments not listed above:
Applicant(s) Statement

I/We have completed this request for credit in consideration of MSA lending to me and/or others upon my guarantee. I/We certify that all information contained herein is accurate and complete to the best of my knowledge.

I/We have read and understand MSA's Privacy Statement.

I/We authorize MSA to retain property of this application, to rely on the foregoing, to check and verify my credit, employment and salary history, to secure follow up credit reports concerning my credit worthiness and to exchange information about my account with proper persons, creditors and credit bureaus.

I authorize my employer (present and future), bank and other references listed above to release and/or verify information to MSA at any time. I acknowledge that this application is subject to approval of credit and acceptance by MSA. Should my request for credit and subsequent loan be approved, I agree to give MSA written notice immediately upon change of my name, address, employment or any other pertinent information contained herein.

By submitting this application I/We AGREE with the above statement.