Member FDIC | Equal Housing Lender

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

Important Applicant Information: Federal law requires institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

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

Applicants must reside in one of the following Indiana counties: Wabash, Miami, Kosciusko, Whitley, Allen, Noble, Elkhart, Marshall, Fulton, Cass, Howard, Grant, Huntington. Please contact your nearest Crossroads branch if you reside outside of these counties.

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.

Instructions:
1. Complete application on-line and click "Submit Application."
2. 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, we will send you the proper disclosures.

Auto Loan Request
Purpose of Loan: (required)
Amount Requested: (required)
Type of Application: (required)
If you are applying for Joint Credit, please insert your initials below:
Applicant InitialsCo-Applicant Initials

 
Term Requested:
Vehicle Description
Year of VehicleMakeModel

 
Purchase PriceDown Payment

 
Applicant
First NameMiddle InitialLast Name

 
Date of BirthSocial Security No.

 
Your E-mail Address

 
Home PhoneWork Phone

 
Marital Status
Residence
Your Primary Residence: (required)
Address Information (required)
Years At Present AddressYour Monthly rent or Mortgage Payment

 
Your Previous AddressYears at Previous Address

 
Nearest Relative NOT living with you:
Phone:
Relationship:
Home Information
Property Address (If different from above)Years in this Area

 
Current Mortgage Holder

 
Purchase PriceMarket ValueMortgage Balance

 
Employment
Your Present EmployerPhone

 
Address Information (required)
Monthly Gross SalaryPosition/TitleEmployment Date

 
_

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 EmployerYears at Previous Employer

 
Address Information (required)
Additional Information
Your Checking Account NumberInstitution Name

 
Your Savings Account NumberInstitution 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.

 
Your E-mail Address

 
Home PhoneWork Phone

 
Marital Status
Co-Applicant Residence
Your Primary Residence:
Address Information
Years At Present AddressYour Monthly Rent or Mortgage Payment

 
Your Previous AddressYears at Previous Address

 
Nearest Relative NOT living with you:
Phone:
Relationship:
Co-Applicant Home Information
Property Address (If different from above)Years in this Area

 
Current Mortgage Holder

 
Purchase PriceMarket ValueMortgage Balance

 
Co-Applicant Employment
Your Present EmployerPhone

 
Address Information
Monthly Gross SalaryPosition / TitleEmployment Date

 
_

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 EmployerYears at Previous Employer

 
Address Information
Co-Applicant Additional Information
Your Checking Account NumberInstitution Name

 
Your Savings Account NumberInstitution Name

 
Name of CreditorApprox. BalanceMonthly PaymentCollateral, if any

 

 

 

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

 
Contact Method
What is the best option to contact you?
Phone NumberEmail Address

 
NOTICE:

Note: By signing this application I hereby certify that the information is true, correct, and complete. There are no other debts or obligations except as listed and these are correct to the best of my knowledge. I further certify that no litigation is pending against me and I have not applied for or have been adjudicated bankrupt except as indicated on this application. You may investigate any of the information provided by me for the purposes of opening and maintaining an account. All applicable information provided to you shall be used and maintained in accordance with the Fair Credit Reporting Act. 

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