Consumer Loan Application › First National Bank

I am applying for Individual Credit Joint Credit

Loan Request

Amount Requested*

Purpose*

Term (in months)*

Collateral*

Applicant

Name*

Date of Birth*

Last 4 Digits of SSN*

Phone*

Email*

Dependents*

Mailing Address

Street*

City*

State*

Zip*

Street Address

Street*

City*

State*

Zip*

Last Address (if < 3 years at current address)

Street

City

State

Zip

Current Employer

Name*

Yrs There*

Position*

Street Address*

City*

State*

Phone*

Previous Employer

Name*

Yrs There*

Position*

Street Address*

City*

State*

Phone*

Nearest Relative not Living with You

Name*

Relationship*

Address*

City*

State*

Zip*

Co-Applicant

Name

Date of Birth

Last 4 Digits of SSN

Phone

Email

Dependents

Mailing Address

Street

City

State

Zip

Street Address

Street

City

State

Zip

Current Employer

Name

Yrs There

Position

Street Address

City

State

Phone

Previous Employer

Name

Yrs There

Position

Street Address

City

State

Phone

Nearest Relative Not Living With You

Name

Relationship

Street Address

City

State

Zip

Gross Monthly Income

Base Employment Income

Applicant

Co-Applicant

Total

Overtime

Applicant

Co-Applicant

Total

Bonuses/Commissions

Applicant

Co-Applicant

Total

Dividends/Interest

Applicant

Co-Applicant

Total

Other Income (Describe Below)

Applicant

Co-Applicant

Total

Applicant

Co-Applicant

Total

*Description of Other Income

Notice: Alimony, child support, or other separate maintenance income need not be revealed if the applicant or co-applicant does not choose to have it considered as a basis for repaying the loan.

Which Applicant

Applicant

Co-Applicant

Source Of Income

Monthly Amount

Which Applicant

Applicant

Co-Applicant

Source Of Income

Monthly Amount

Which Applicant

Applicant

Co-Applicant

Source Of Income

Monthly Amount

Which Applicant

Applicant

Co-Applicant

Source Of Income

Monthly Amount

Current Monthly Housing Expenses

First Mortgage or Rent

Other Financing on Home

Homeowners Insurance

Real Estate Taxes

Association Dues

Total

These Questions Apply to Both the Applicant and Co-Applicant

Are there any outstanding judgments against you?

Applicant* Yes No

Co-Applicant Yes No

Have you been declared bankrupt in the past 7 years?

Applicant Yes No

Co-Applicant Yes No

Have you had property foreclosed upon or given title or deed in lieu of in the past 7 years?

Applicant Yes No

Co-Applicant Yes No

Are you party to a law suit?

Applicant Yes No

Co-Applicant Yes No

Are you obligated to pay alimony, child support or separate maintenance?

Applicant Yes No

Co-Applicant Yes No

Are you a co-maker or endorser on a note?

Applicant Yes No

Co-Applicant Yes No

Are you a U.S. Citizen?

Applicant Yes No

Co-Applicant Yes No

If “No”, are you a resident alien?

Applicant Yes No

Co-Applicant Yes No

If “No”, are you a non-resident alien?

Applicant Yes No

Co-Applicant Yes No

Answer Explanations

Applicant

Co-Applicant

Assets

The First N.A. Checking Current Value*

The First N.A. Savings/CD Current Value*

Other Bank Accounts

Current Value

Stocks, Bonds, Mutual Funds

Current Value

Vehicles

Current Value

Other Real Estate

Current Value

Other Assets

Current Value

Life Insurance

Life Insurance Face Value

Life Insurance Cash Value

Home

Current Value

Total Assets (A)

Liabilites

Mortgage/Rent

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Other Real Estate Payments

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Vehicle Loans

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Credit Cards

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Monthly Payment

Unpaid Balance

Child Support and/or Alimony Payments

Monthly Payment

Unpaid Balance

Total Liabilities (B)

Total Net Worth (A-B)*

Notice of Sale of Insurance
This document is an application for a loan. In conjunction with the application the Lender (First National Bank) may solicit, offer to sell, or will sell an insurance product or annuity. Federal law requires that the following disclosures be provided to you.
Credit Disclosure	Lender, as a condition of granting you a loan, cannot require that you purchase an insurance product or annuity from Lender or any of its affiliates. Lender, as a condition of granting you a loan, cannot require
Insurance Disclosure	The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, the bank or an affiliate of the bank. The insurance product or annuity is not insured by the Federal Deposit Insurance Corporation (FDIC) or any agency of the United States, the bank, or an affiliate of the bank. In the case of an insurance product or annuity that involves investment risk, there is investment risk associated with the product including the possible loss of value.

Applicant Acknowledgement

Consumer reports (credit reports) may be obtained in connection with your loan application. (1) if you request, you will be informed whether or not consumer reports were obtained. (2) If reports were obtained. If you request, you will be informed of the names and addresses of the consumer reporting agencies (credit bureaus) that furnished the reports. You must insure real or personal property securing your loan in accordance with the requirements of the loan documents. You may purchase such insurance through any insurance agent and from any insurance company that is reasonable to us. We may report information about your account to credit bureaus, late payments, missed payments, or other defaults on your account may be reflected in your credit report. My/our signature below authorizes First National Bank to obtain a credit report, loan balances, or payoff information and to verify employment information listed herein.

This application is submitted to obtain credit and I hereby acknowledge receipt of the disclosures contained herein and certify that all information herein is true and complete.

Applicant's Signature

Date

Co-Applicant's Signature

Date

Only Complete the Following Section if the Purpose of this Request is to Purchase, Refinance, or Make Improvements to a Dwelling

Information for Government Monitoring Purposes

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 not discriminate either on a basis of this information, or on whether you choose to furnish it. If you 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 and surname if you have made this application in person. If you do not wish to furnish this 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).

To be Completed by Interviewer:

Information Provided By Face To Face Interview
Telephone Interview
Applicant Via Mail or Fax
Applicant Via Internet