Consumer Credit Application
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2FIRST STATE BANK - Lynnville, Iowa
CONSUMER CREDIT APPLICATION
Important Applicant Information: Federal law requires financial institutions to obtain suffcient 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 this information. The information you provide
is protected by our privacy policy and federal law.
TYPE OF CREDIT REQUESTED
Individual Credit -
Secured
relying solely on my income or assets
Individual Credit -
Unsecured
relying on my income or assets as well as income or assets from other sources
Joint Credit -
we intend to apply for joint credit. (initials)____________________
Amount Requested
Term (mos)
Payment Date Requested Loan Purpose:
$
COLLATERAL DESCRIPTION
Property Description:
INDIVIDUAL APPLICANT INFORMATION
NAME (Last, First, Middle Initial)
BIRTHDATE
SOCIAL SECURITY NUMBER
ADDRESS (Street, City, State & Zip Code)
TELEPHONE NUMBER
Own or Rent?
HOW LONG?
Own
PREVIOUS ADDRESS (Street, City, State & Zip Code) (If less than 2 years at current address)
Own or Rent?
HOW LONG?
Own
EMPLOYER (Name & Address)
BUSINESS PHONE NUMBER
HOW LONG?
POSITION OR TITLE
GROSS SALARY
$
Annually
Monthly
Hourly, if so hrs/ week __________
PREVIOUS EMPLOYER (Name & Address)
POSITION OR TITLE
HOW LONG?
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
TELEPHONE NUMBER
RELATIONSHIP
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.
Alimony, Child Support, Separate Maintenance received under:
Court Order
Written Agreement
Oral Understanding
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?
No
Yes (explain)
JOINT APPLICANT OR OTHER PARTY INFORMATION
Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.
REALTIONSHIP TO APPLICANT (If Any)
NAME (Last, First, Middle Initial)
BIRTHDATE
SOCIAL SECURITY NUMBER
ADDRESS (Street, City, State & Zip Code)
TELEPHONE NUMBER
Own or Rent?
HOW LONG?
Rent
PREVIOUS ADDRESS (Street, City, State & Zip Code) (If less than 2 years at current address)
Own or Rent?
HOW LONG?
Rent
EMPLOYER (Name & Address)
BUSINESS PHONE NUMBER
HOW LONG?
POSITION OR TITLE
GROSS SALARY
$
Annually
Monthly
Hourly, if so hrs/ week __________
PREVIOUS EMPLOYER (Name & Address)
POSITION OR TITLE
HOW LONG?
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.
Alimony, Child Support, Separate Maintenance received under:
Court Order
Written Agreement
Oral Understanding
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?
No
Yes (explain)
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