Personal Loan Application
Submitter Information (Required)
First Name (required)
Last Name (required)
Resolve the errors marked in red before submitting again.

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

Applicants must reside in Pennsylvania: Bradford, Lackawanna, Luzerne, Monroe, Pike, Susquehanna or Wayne Counties; in New York: Delaware or Sullivan Counties and be at least 18 years of age.

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 online 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.

Instructions:
1. Print this loan application and gather the information you'll need.
2. Complete application online and click "Submit Application" or fax it to 570-253-5263.
3. To safeguard your privacy, QUIT your browser and restart it again after using this form.

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. Upon receipt of the application, you will be be sent all accompanying disclosures.

Applicant
First NameMiddle InitialLast Name
(required)
 
(required)
Date of BirthSocial Security NumberNumber of Dependents
(required) (required) (required)
Driver's License NumberDriver's License StateYour Email Address
(required) (required) (required)
Home PhoneMobile PhoneWork PhoneBest Time to Call
(required)
 

 

 
Marital Status
If the applicant is married, he or she may apply for individual credit. Check one if you are applying for a secured credit, you reside in a community property state, or you are relying on property in a community property state as a basis for repayment.
Are there any unsatisfied judgements against you? (required)
Have you declared bankruptcy in the past seven 7 years? (required)
U.S. Citizen (required)
Personal Loan Request
Amount Requested: (required)
Type of Application: (required)
Purpose of Loan:
Term Requested (required)
Residence
Your Primary Residence Details: (required)
Present Address (required)
Years at Present Address
Monthly Rent or Mortgage Payment
Previous AddressYear at Previous AddressMonthly Rent or Mortgage Payment

 

 

 
Home Information
Collateral Property Address (If different from above)Date Purchased

 

 
Current Mortgage HolderMortgage Holder Phone

 

 
Purchase PriceMarket ValueMortgage Balance

 

 

 
Employment
Your Present EmployerPhone

 

 
Present Employer Address Information
Gross Monthly SalaryTitleYears Employed

 

 

 
Previous Employer (if less an 3 years at current employer)Years at Previous Employer

 

 
Previous Employer Address

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 Income Sources
Income TypeSource of Other IncomeAmountFrequency

 

 

 

 
Banking Information
Checking Account NumberInstitution Name

 

 
Savings Account Number.Institution Name

 

 
Name of CreditorApproximate BalanceMonthly PaymentCollateral (if any)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Total Amount of Other Monthly Payments not listed above:
AssetsValueTitle Held Name

 

 

 
Co-Applicant
First NameMiddle InitialLast Name

 

 

 
Date of BirthSocial Security NumberNumber of Dependents

 

 

 
Driver's License NumberDriver's License StateEmail Address

 

 

 
Home PhoneMobile PhoneWork Phone

 

 

 
Co-Applicant Residence
Your Primary Residence:
Present Address
Years At Present AddressMonthly Rent or Mortgage Payment

 

 
Previous AddressYears at 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
Present EmployerPhone

 

 
Address Information
Gross Monthly SalaryTitleYears Employed

 

 

 
Previous Employer (if less than 3 years at current employer)Years Employed

 

 

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 Income Sources
Income TypeSource of Other IncomeAmountFrequency

 

 

 

 
Co-Applicant Additional Information
Checking Account NumberInstitution Name

 

 
Savings Account NumberInstitution Name

 

 
Name of CreditorApproximate BalanceMonthly PaymentCollateral (if any)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Total Amount of Other Monthly Payments not listed above:
AssetsValueTitle Held Name

 

 

 
Applicant(s) Statement

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

I/We acknowledge that by submitting this form I/we AGREE with the above statement.

 

Member FDIC     Equal Housing Lender     NMLS ID#: 446237