Consumer Installment Loan Application


This application for non-mortgage loans only.
For a mortgage application, please click here.

* Type of Credit Requested:
Secured
Unsecured
Amount of Loan:
How Long?
Select One:
Individual Credit-relying on my income or assets.
Individual Credit-relying on my income or assets as well as income or assets from other sources.
Joint Application
Payment Date Desired:
Want to Repay:
Monthly
Other
Specify:
Purpose:
Account No.:
Class:

 

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SECTION A- INDIVIDUAL APPLICANT INFORMATION

* Last Name
* First Name
Birth Date
* Telephone Number
Social Security Number

Present Address

City

State

Zip

Country
How Long?

Previous Address

City

State

Zip

Country
How Long?

* Have you applied for credit with us before:
No
Yes
When:
Number of Dependents:
Dependents Ages:

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Section A - Continued

Name of Nearest Relative Not Living With You
Relationship
Address
Telephone Number

* Employer
(Company Name and Address)

How Long?

Business Telephone

Position/Title
How Often Paid
Take Home Salary Per Month
Previous Employer
(Company Name and Address)
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:

 

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SECTION B- JOINT APPLICATION OR OTHER PARTY INFORMATION


Complete only if:
for joint credit relying on income or assets from other sources, or applicants is married and resides in a community property state.

Regulation B Notice of Intent to Apply for Joint Credit
Notice: We intend to apply for join credit.

Acknowledgment:

By signing below, we acknowledge the intention to apply for joint credit on today's date.

 

Name
(Last, First, MI)
Birth Date
Telephone Number
Social Security Number

Present Address

City

State

Zip

Country
How Long?

Relationship to Applicant (if any)
Have you applied for credit with us before?
No
Yes
When:
Number of Dependents
Dependents Ages

 

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Section B - Continued

Name of Nearest Relative Not Living With You
Relationship
Address
Telephone Number

Employer
(Company Name and Address)

How Long?

Business Telephone

Position/Title
How Often Paid
Take Home Salary Per Month
Previous Employer
(Company Name and Address)
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:

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Section C - Marital Status

Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state.
* Includes single, divorced and widowed
Applicant Other Party
Married
Separated
Unmarried*
Married
Separated
Unmarried*

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Section D - Asset & Debit Information

If Section B has been completed, this Section should be completed giving information about both the Applicant and Joint Applicant or Other Person. Please mark Applicant- related information with an "A." If Section B was not completed only give the information about the Applicant in this Section.
Checking Account Number(s)
(Where)
Name in which the account is carried:
Value:$
Savings Account Number(s)
(Where)
Name in which the account is carried:
Value:$
Other Assets
(describe)
Name in which the account is carried:
Value:$
Total Assets:$

Outstanding Debts

Include charge accounts, installment contracts, credit cards, rent, mortgages and other obligations.
Creditor Account Number Name Account is Under Original Amount Present Balance Monthly Payments
Landlord/Mortgage Holder
Rent Pmt.
Mortgage
(Omit Rent)
(Omit Rent)
Automobiles
(Make,Model Year)
   
Total Debts

 

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Section D - Continued

Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable)
Are you obligated to make Alimony,
Support or Maintenance Payments?
No
Yes
If yes, to (Name and Address)
Amount Per Month

Are you a comaker, endorser, or
guarantor on any loan or contract?
No
Yes
If yes, for whom?
To whom?
Are there any unsatisfied judgments against you?
No
Yes
If yes, to whom owed?
Amount
Have you been declared bankrupt in the last 10 years?
No
Yes
If yes, where?
Year

 

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Section E - Secured Credit

Complete only if credit is to be secured. Briefly describe the property to be given as security and indicate if others have ownership interest.
Property Description
Name and Address of all co-owners of the property
If the security is real estate, give the
full name of your spouse (if any)

SIGNATURES-I certify that everything I have stated in this application and on any attachments is correct. You may keep this information whether or not it is approved. By signing below I authorize you to check my credit and employment history and to answer questions others my ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.
Applicant:
  Date:
Other:
  Date:

 

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 with this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING THE EXTENTION 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.

Applicant:
  Date:
Other:
  Date:

Notice Regarding Inaccurate Information
As a participant in the consumer reporting system, we furnish information about our experience with you to consumer reporting agencies. These consumer reports allow us to make credit and other opportunities available to you. If you believe that we have furnished information to a consumer reporting agency that is inaccurate please notify us at P.O. Box 462, LaSalle, IL 61301 and identify the specific information that is inaccurate.

Federal law requires us to provide the following notice to customers before any “negative information” may be furnished to a nationwide consumer reporting agency. “Negative information” means information concerning delinquencies, late payments, insolvency, or any form of default. This notice does not mean that we will be reporting such information about you, only that we may report such information about customers that have not done what they are required to do under our agreement.

After providing this notice, additional negative information may be submitted without providing another notice.

*   *   *   *

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.

 


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