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

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.

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Type of Credit Requested
Type of Loan (required)
Individual or Joint (required)
Amount Requested (required)
Term of Loan In Months (required)
Payment Date Desired
Proceeds of Loan to be Used For (required)
Referred By
Applicant Personal Information
First NameMiddle InitialLast Name
(required) (required) (required)
Social Security Number
(required) (required) (required)
Date of Birth (required)
Driver's License No.Driver's License State
(required) (required)
Phone (required)
Email (required)
Verify Email (required)
Contact Information
Choose your location where you would like to complete your application (required)
How Would You Prefer to be Contacted? (required)
When is the best time to arrange an appointment? (required)
Current Address
Home Address Not a P.O. Box (required)
County (required)
Years At Home Address (required)
Home Status (required)
Previous Address
Previous Address Not a P.O. Box
Years At Previous Address
Dependent and Relative Information:
Number of DependentsAge of Dependents


Relative Address Not a P.O. Box
Relative Phone Number
Applicant Current Employer
Employer's NameEmployer's Phone
(required) (required)
Employers Address (required)
Your Position
Years at Company
Applicant Previous Employer
Previous Employer's NamePrevious Employer Phone


Previous Employers Address
Years at Previous Company
Other Income Sources
Alimony, child support, separate maintenance income received under:* (required)
*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.
Sources of Other Income
Amount Per Month
Is any income listed in this Section likely to be reduced before the credit request is paid off?
Have you previously received credit from us?
Applicant Marital Status
Complete only if: for joint or secured credit, or applicant resides in a community property state, or is relying on property located in such a state as a basis for repayment of the credit requested.
Co-Applicant Marital Status
Asset & Debt Information - Checking Account
Checking Bank Name
Checking Bank Address
Name in Which the Account is Carried
Is this Account Subject to Debt?
Asset & Debt Information - Savings Account
Savings Account Number
Savings Balance
Savings Bank Name
Savings Bank Address
Name in Which the Account is Carried
Asset & Debt Information - Certificate of Deposit
Certificate of Deposit Value
Certificate of Deposit Bank Name
Certificate of Deposit Bank Address
Name in Which the Account is Carried
Asset & Debt Information - Marketable Securities Assets
Marketable Securities Value
Number of Shares
Name in Which the Asset is Carried
Asset & Debt Information - Real Estate Assets
Real Estate Address
Date Aquired
Name in Which the Asset is Carried
Asset & Debt Information - Life Insurance Assets
Life Insurance Face Value
Name in Which the Asset is Carried
Asset & Debt Information - Automobile Assets
Automobile Value



Name in Which the Asset is Carried
Asset & Debt Information - Other Assets
Name in Which the Asset is Carried
Asset & Debt Information - Rent or Mortgage Payment
Rent or Mortgage Payment
Landlord or Mortgage Holder
Name in Which the Lease or Mortgage is Carried
Monthly PaymentOriginal Amount (Mortgage)Present Balance (Mortgage)



Asset & Debt Information - Automobile Debt
Automobile Creditor If applicable
Loan Account Number
Automobile Information
Make Model Year



Name in Which the Loan is Carried
Original Amount
Present Balance
Monthly Payment
Asset & Debt Information - Other Debt
Account Number
Name in Which the Debt is Carried
Debt Information
Original AmountPresent BalanceMonthly Payment



Secured Credit
Property Description
Co-Owner Name
Co-Owner Address
If the security is real estate, give the full name of your spouse if any
Applicant(s) Statement

By clicking Submit below, I/we certify that everything stated in this application is correct. Flanagan State Bank may keep this application whether or not it is approved. By submitting this application I/we authorize Flanagan State Bank to check my/our credit and employment history and to answer questions others may ask Flanagan State Bank about my credit record with Flanagan State Bank. I/we understand that I/we must update credit information at the request of Flanagan State Bank if my financial condition changes.