Consumer Loan Application

Important Information About Procedures for Applying for a Loan:

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 to You:

When you open a new 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.

Our Privacy Policy:

Protection of your privacy is important to us. To read more about how we protect your personal information, review our Privacy Policy link at the bottom of the page.

Your Credit History:

As part of processing your application we will request a credit report and use the information contained in it to evaluate your loan application.

* Required

Purpose of Loan *

Amount Requested *

Credit Type

APPLICANT(S) You may apply for separate or joint credit. Select one of the following:

a. If you are applying for individual credit or an individual account, in your own name, and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete Section I.

b. If you are applying for joint credit with another person or for a joint account or an account that you and another person will use, complete all sections regarding primary and joint applicants (Section I and II).

Applicant Information Section I

First Name *

Last Name *

Best Contact Method *

Phone

Email Address *

Phone Number *

Current Address

City

State

Zip Code

Previous Address (If less than two years)

City

State

Zip Code

Please indicate marital status

Own or Rent?

Years There

Current Rent (if rent)

Social Security Number *

Date of Birth *

Employer *

Years at Employment

Position

Income (Please indicate hourly, monthly, or annual) *

Previous Employer (If with current employer less than two years)

Co-Applicant Joint Credit Section II

First Name

Last Name

Best Contact Method

Phone

Email Address

Phone Number

Current Address

City

State

Zip Code

Previous Address (If less than two years)

City

State

Zip Code

Please indicate marital status

Own or Rent?

Years There

Current Rent (if rent)

Social Security Number

Date of Birth

Employer

Years at Employment

Position

Income (Please indicate hourly, monthly, or annual)

Previous Employer (If with current employer less than two years)

Debts and Obligations

First Mortgage Lender Name

Monthly Payment

Unpaid Balance

Second Mortgage Lender Name

Monthly Payment

Unpaid Balance

Other Debts (Auto, Recreational, Credit Card, Etc.)

Description

Monthly Payment

Unpaid Balance

Description

Monthly Payment

Unpaid Balance

Description

Monthly Payment

Unpaid Balance

Description

Monthly Payment

Unpaid Balance

Description

Monthly Payment

Unpaid Balance

Additional Comments

I/We have read the E-Sign Disclosure and Consent, and I consent to receive communications via the methods described. *

Authorization to Release Information

I authorize Local Bank to obtain my/our credit report for the purpose of determining credit worthiness. The information that is obtained is strictly confidential. A photocopy or fax of this authorization may be deemed to be the equivalent of the original. *

If you have been working with a particular Local Bank Representative please provide their name:

By entering my name below, I certify that everything I have stated in the application is correct and accurate to the best of my knowledge. *

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