Member FDIC | Equal Housing Lender
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.
Applicant Initials | Co-Applicant Initials | |
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Year of Vehicle | Make | Model | |
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Purchase Price | Down Payment | |
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First Name | Middle Initial | Last Name | |
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Date of Birth | Social Security No. | |
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Your E-mail Address | |
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Home Phone | Work Phone | |
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Years At Present Address | Your Monthly rent or Mortgage Payment | |
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Your Previous Address | Years at Previous Address | |
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Property Address (If different from above) | Years in this Area | |
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Current Mortgage Holder | |
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Purchase Price | Market Value | Mortgage Balance | |
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Your Present Employer | Phone | |
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Monthly Gross Salary | Position/Title | Employment Date | |
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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 Income | Source of Other Income | |
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Previous Employer | Years at Previous Employer | |
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Your Checking Account Number | Institution Name | |
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Your Savings Account Number | Institution Name | |
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Name of Creditor | Approx. Balance | Monthly Payment | Collateral, if any | |
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First Name | Middle Initial | Last Name | |
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Date of Birth | Social Security No. | |
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Your E-mail Address | |
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Home Phone | Work Phone | |
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Years At Present Address | Your Monthly Rent or Mortgage Payment | |
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Your Previous Address | Years at Previous Address | |
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Property Address (If different from above) | Years in this Area | |
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Current Mortgage Holder | |
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Purchase Price | Market Value | Mortgage Balance | |
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Your Present Employer | Phone | |
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Monthly Gross Salary | Position / Title | Employment Date | |
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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 Income | Source of Other Income | |
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Previous Employer | Years at Previous Employer | |
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Your Checking Account Number | Institution Name | |
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Your Savings Account Number | Institution Name | |
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Name of Creditor | Approx. Balance | Monthly Payment | Collateral, if any | |
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Assets | Value | Title Held Name | |
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Phone Number | Email Address | |
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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.