Member FDIC | Equal Housing Lender

Debt Consolidation 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 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.

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Instructions:
1. Print this loan application and gather the information you'll need.
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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.

Debt Consolidation Loan Request
Amount Requested:
Type of Application:
Applicant
First NameMiddle NameLast 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

 
Are there any unsatisfied Judgments against you?
Have you been declared bankrupt in the last 7 years?
Residence
Your Primary Residence:
Present Street 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 PositonYears 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:
AssetsValueTitle Held Name

 
Co-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

 
Co-Applicant Residence
Your Primary Residence:
Present Street 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 PositonYears 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:
AssetsValueTitle Held Name

 
Information For Government Monitoring Purposes

This section to be completed only for loans subject to reporting under the Home Mortgage Disclosure Act (HMDA).

HMDA loans are loans made for the following purposes: Home Purchase (secured), Home Improvement (secured or unsecured), or refinance of a loan secured by a 1-4 residential dwelling (regardless of purpose).

The following information is requested by the Federal government for certain types of loans related to a dwelling, in order to monitor the Lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it.

If you choose to furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this Lender is required to note the information on the basis of visual observation or surname.

If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)

Applicant:
Ethnicity
Race or National Origin:
Sex
Co-Applicant:
Ethnicity
Race or National Origin:
Sex
Applicant(s) Statement

I/We hereby apply for the loan or credit described in this application. I/We certify that I/we made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information.

I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose.  Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. 

I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted.  These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. 

I/We further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.  I understand and agree that Lender may obtain, use and share my state and federal tax return information for purposes of: 1) reviewing and responding to my loan application; 2) originating the loan; 3) servicing the loan; 4) selling or transferring all or a part of the loan or any interest in it; and  5) internal marketing analysis, marketing to me, and other marketing as permitted by law. I understand to accomplish these purposes Lender may need to share this information with Third Parties, including loan servicers, actual or potential purchasers or investors in loans, government agency loan guarantors, mortgage insurers, marketing companies, etc., depending on the type of loan I have applied for, and I agree to such information sharing for these purposes.  For the purpose of this consent to sharing tax return information, Lender and Third Parties includes the affiliates, agents and any successors or assigns of Lender and Third Parties.

 

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