PERSONAL LOAN APPLICATION
Date:
Member FDIC
5,000
Reason for Loan: Medical
I wish to borrow $
Main
Branch
for
2/16/2022
24
months
IMPORTANT! Read these directions before completing this Application.
✔
Check
Appropriate
Box
INDIVIDUAL CREDIT- relying on my income or assets. Complete only section A. [Applicant Information].
JOINT CREDIT Complete section A. [Applicant Information] and complete section B.[Information Regarding Joint Applicant or Other
Party] about the joint applicant.
We intend to apply for joint credit.
Applicant's Signature
Co-applicant's Signature
INDIVIDUAL CREDIT- relying on my income or assets as well as income or asset from other sources. Complete section A. [Applicant
Information] and, to the extent possible provide information in section B. [Information Regarding Joint Applicant or Other Party] about the
person on whose alimony, support, or maintenance payments or income or assets you are relying.
A. APPLICANT INFORMATION
Applicant's Name
Date of Birth
John Smith
Drivers License #
11-24-2000
E-Mail Address
Social Security #
23454344
453-44-3433
Home Telephone Number
Cell Phone Number
City, State, Zip
How Long?
johnsmith97@email.com
Mailing Address
956-244-6355
Street Address
123 Water ST
123 Water ST
Previous Address
Laredo, Texas 78040
City, State, Zip
Occupation
Years there
Teacher
Phone #
Employer
10
LISD
Address
956-273-6200
Former Employer
Gross Pay
$
80,000
per
80,000
$_________________
Year
Amount of Income You Want Considered
3
Other Income
$
n/a
Yes
Is your income likely to be reduced before this loan is paid off?
Explain:
Are you a Co-Maker, Endorser, or Guarantor on any loan or contract?
Yes
If "yes", for whom?
To whom?
Name of Current Bank
Checking Account
Savings Account
$ 2,000
123 Water St
Years there
BBVA
"You need not disclose alimony, child support, or separate maintenance
payments if you do not want us to consider such income in determining the
repayment of this obligation".
BBVA
10 years
How Long?
Source of other income
n/a
per
No
✔
No
✔
$ 1,000
Certificate of Deposit
$0
Name and Address of TWO Nearest Relatives and ONE Friend Not living With You (Not Present or Former Spouse)
Name
Address
Relationship
Julie Garner
2341 Rocky rd
Co-worker
956-324-5366
Sam Donald
1235 Web St
Supervisor
945-234-5344
House Payment
Balance of 1st Mortgage
Balance of 2nd Mortgage
Equity
Home Insurance Carrier - Agent/Phone
Rent
Other
Payment Amount
Landlord or 1st Mortgage Holder
2nd Mortgage Holder
$
Vehicle Information
Year Make
10
Phone #
chrysler
Model
200
Vehicle Insurance (Company, Agent, Name, & Phone)
Financed by
BBVA
Geico
B. INFORMATION REGARDING JOINT APPLICANT, OR OTHER PARTY
Applicant's Name
Date of Birth
E-Mail Address
Mailing Address
Street Address
Previous Address
Occupation
Years there
Drivers License #
Social Security #
Home Telephone Number
Cell Phone Number
City, State, Zip
How Long?
City, State, Zip
How Long?
Employer
Gross Pay
$
Phone #
Address
Former Employer
Years there
Other Income
Source of other income
per
$_________________
Amount of Income You Want Considered
"You need not disclose alimony, child support, or separate maintenance
payments if you do not want us to consider such income in determining the
repayment of this obligation".
$
Is your income likely to be reduced before this loan is paid off?
Yes
Explain:
Are you a Co-Maker, Endorser, or Guarantor on any loan or contract?
Yes
If "yes", for whom?
To whom?
Checking Account
Savings Account
Name of Current Bank
$
$
per
No
No
Certificate of Deposit
$
Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this
application whether or not it is approved. You are authorized to check my credit and employment history and to answer
questions about your credit experience with me.
Applicant's Signature
Date
Other Signature (where applicable)
Date
Bank Employee's Signature (If application taken by telephone)
FEDERAL CREDIT APPLICATION INSURANCE DISCLOSURE
I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance product or annuity in connection with this
extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING THE EXTENSION OF CREDIT ON EITHER:
1. My purchase of an insurance product or annuity from you or from any of your affiliates; or
2. My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity.
By signing, I acknowledge that I have received a copy of this form on today’s date. Unless this disclosure is provided electronically or I have applied
for credit by mail, I also acknowledge that you have provided this disclosure to me orally.
Consumer
Date
Consumer
Date