Member FDIC - Equal Housing Lender

Privacy Statement

Personal Loan Application
Submitter Information (Required)
First Name
(required)
Last Name
(required)
File Upload Form. Follow these instructions to upload files.

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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 us online.

Applicants must reside in Pennsylvania, Ohio or New York.

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. Upon receipt of the application, we will send you the proper disclosures.

Loan Request
Amount Requested:
Type of Application:
Term Requested:
What will the loan funds be used for?
Will this loan be secured by personal property?
If yes, please list the description of the collateral to be used for this loan.
Applicant
First NameMiddle InitialLast Name

 
Home PhoneMobile PhoneWork PhoneBest Time to CallEmail Address

 
Date of BirthSocial Security No.

 
Driver's License No.Driver's License StateDriver's License Issue DateDriver's License Expiration Date

 
Upload a picture of the front of your Driver's License
Citizenship (required)
Are there any unsatisfied Judgments against you?
Have you been declared bankrupt in the last 7 years?
Residence
Your Primary Residence:
Address Information
Years At Present AddressYour Mortgage or Rent Payment

 
Years At Previous AddressYour Previous Address

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

 
Current Mortgage Holder

 
Purchase PriceEstimated Property ValueMortgage Balance

 
Annual Property Tax AmountAnnual Homeowner Insurance Amount

 
Employment
Employer NamePhone

 
Address Information
Gross Monthly SalaryYour PositionHow many years have you worked here

 

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.

Paystubs covering a full month's income
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 NumberInstitution Name

 
Name of CreditorApprox. BalanceMonthly PaymentCollateral, if any

 

 

 

 
Total Amount of Other Monthly Payments not listed above:
Co-Applicant
First NameMiddle InitialLast Name

 
Home PhoneMobile PhoneWork PhoneBest Time to CallEmail Address

 
Date of BirthSocial Security No.

 
Driver's License No.Driver's License StateDriver's License Issue DateDriver's License Expiration Date

 
Upload a picture of the front of your Driver's License
Citizenship (required)
Are there any unsatisfied judgments against you?
Have you been declared bankrupt in the past 7 years?
Co-Applicant Residence
Your Primary Residence:
Address Information
Years At Present AddressYour Mortgage or Rent Payment

 
Years At Previous AddressYour Previous Address

 
Co-Applicant Home Information (only complete if different from applicant)
Collateral Property Address (If different from above)Date Purchased

 
Current Mortgage Holder

 
Purchase PriceEstimated Property ValueMortgage Balance

 
Annual Property Tax AmountAnnual Homeowner Insurance Amount

 
Co-Applicant Employment
Employer NamePhone

 
Address Information
Gross Monthly SalaryYour PositionHow many years have you worked 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.

Paystubs covering a full month's income
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 NumberInstitution Name

 
Name of CreditorApprox. BalanceMonthly PaymentCollateral, if any

 

 

 

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

 
Automatic Loan Payment
Do you wish to have your payment automatically deducted from your Farmers Bank checking account? (required)
Your payment may be higher if you do no select an automatic payment.
If Yes, please enter your checking account number:

Automatically transferred funds will be applied as my monthly payment on each monthly due date.  This will occur until I cancel, or the loan is paid in full. I understand the Bank reserves the right to terminate the automatic repayment plan without notice.

Applicant(s) Statement

Applicant(s) Statement 
I/We have completed this request for credit in consideration of The Farmers National Bank of Emlenton 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 Farmers National Bank of Emlenton 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 The Farmers National Bank of Emlenton at any time. I acknowledge that this application is subject to approval of credit and acceptance by The Farmers National Bank of Emlenton. Should my request for credit and subsequent loan be approved, I agree to give The Farmers National Bank of Emlenton written notice immediately upon change of my name, address, employment or any other pertinent information contained herein.

(required)