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BONNEVILLE BANK DIRECT CONSUMER LOAN APPLICATION APPLICANT INFORMATION

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BONNEVILLE BANK
1675 North Second West, Post Office Box 400
Provo, Utah 84604 Telephone(801)3749500
DIRECT CONSUMER LOAN APPLICATION
APPLICANT INFORMATION
Check As Applicable - Applicant is applying for this loan:
ALONE, without a co-signer or guaranty of a relative or other person(s) or entity.
WITH A PERSON OR PERSONS who will also be contractually liable.
Names of other Person(s)
Type of Loan: Personal, Family of Household Business or Investment in Real Estate Rentals
Specific Purpose of Loan:
For $ : Payable in Monthly Installments Beginning:
Applicant’s Full Name
Date of Birth Age
Social Security Number Driver’s License State & No.
Applicant’s Home Address (If Rural, show Road and Box No.)
City State Zip Code
How Long? Yrs. Mos.
Home Phone No. Mobile No.
Email Address
Residence: Home Mobile Home Apartment With Parents Other:
Applicant’s Complete Previous Address
City State Zip Code
How Long? Yrs. Mos.
Closest Relative Not Living With You (Other than Co-Applicant) (Complete Name and Address)
Relationship
Personal Reference (Non-Relative) (Complete Name and Address)
Years Known
BONNEVILLE BANK
1675 North Second West, Post Office Box 400
Provo, Utah 84604 Telephone(801)3749500
Applicant’s Employer (If Self-Employed, Name and Nature of Business)
How Long? Yrs. Mos. What is Your Job?
Business Address
Business Phone Monthly Pay Dates
Take Home Pay $ Weekly or Monthly
Labor Union Local Number and Name
Former Employer - Complete Name and Address
How Long? Yrs. Mos.
Amount of Alimony, Child Support and Maintenance Payment Income: $ Per Mo.
NOTE: Alimony, child support, and maintenance payment income need not be revealed if you do not wish to have it considered as a
basis for repaying this obligation.
No. of Dependents & Ages
Other Income (Pension, Social Security, etc.): Source $ Per Mo.
Name and Address of Payor of Any Alimony, Child Support, or Maintenance Payment Disclosed Above and Relied Upon as
a Source of Repayment.
Where Do You Bank? Branch No. Yrs.
Type of Account: No.
Other Bank or Credit Union Branch No. Yrs.
Have You Ever Borrowed From Any Other Branch of This Bank? Yes No
Which Branch? When?
CO-APPLICANT / OTHER PARTY INFORMATION
Co-Applicant’s Full Name
Date of Birth Age
Social Security Number Driver’s License State & No.
Co-Applicant’s Home Address (If Rural, show Road and Box No.)
City State Zip Code
BONNEVILLE BANK
1675 North Second West, Post Office Box 400
Provo, Utah 84604 Telephone(801)3749500
How Long? Yrs. Mos.
Home Phone No. Mobile No.
Email Address
Residence:
Home
Mobile Home
Apartment Wi
th Paren
ts Other:
Co-Applicant’s Complete Previous Address
City State Zip Code
How Long? Yrs. Mos.
Co-Applicant’s Closest Relative Not Living With Co-Applicant (Other than Applicant)
Relationship
Personal Reference of Co-Applicant (Non-Relative) Complete Name and Address
Years Known
Co-Applicant’s Employer (If Self-Employed, Name and Nature of Business)
How Long? Yrs. Mos. What is Co-Applicant’s Job?
Business Address
Business Phone
Take Home Pay $ Weekly or Monthly
Labor Union Local Number and Name
Former Employer - Complete Name and Address
How Long? Yrs. Mos.
Amount of Alimony, Child Support and Maintenance Payment Income: $ Per Mo.
NOTE: Alimony, child support, and maintenance payment income need not be revealed if you do not wish to have it
considered as a basis for repaying this obligation.
No. of Dependents & Ages
Other Income (Pension, Social Security, etc.): Source $ Per Mo.
BONNEVILLE BANK
1675 North Second West, Post Office Box 400
Provo, Utah 84604 Telephone(801)3749500
Name and Address of Payor of Any Alimony, Child Support, or Maintenance Payment Disclosed Above and Relied Upon as
a Source of Repayment.
Where Does Co-Applicant Bank? Branch No. Yrs.
Type of Account: No.
Other Bank or Credit Union Branch No. Yrs.
Have You Ever Borrowed From Any Other Branch of This Bank? Yes No
Which Branch? When?
INSURANCE
Applicant desires the following voluntary insurance: Credit life Credit disability Both
Co-applicant desires the following voluntary insurance: Credit life Credit disability Both
Agent for Hazard and Liability Insurance (name, address, telephone):
Insurance Company
SIGNATURES
I (we) hereby affirm that the information contained in this application, including the information on the reverse side, is
true, complete and correct and that Lender is relying on this information if it makes the requested loan. Lender is
authorized to make any investigation of my / our credit and / or employment status either directly or through any agency
employed by Lender. Lender may disclose to any other interested parties Lender’s experience with my / our loan account.
Lender may keep this application even it it decides not to make the loan to me / us.
Date
Applicant’s Signature
Co-Applicant’s or Other Party Signature
Mailing Address Mailing Address
SPOUSAL CONSENT (If you are relying on income from your spouse or former spouse who is not an applicant above,
please have your spouse or former spouse complete this section so that we may verify their credit.)
I authorize Lender to make any investigation of my credit either directly or through any agency employed by Lender for
that purpose in connection with this credit application by my spouse or former spouse.
Date
Signature Social Security Number
BONNEVILLE BANK
1675 North Second West, Post Office Box 400
Provo, Utah 84604 Telephone(801)3749500
PLEASE INDICATE CO-OWNERSHIP
Statement of financial condition of as of
ASSETS AMOUNT LIABILITIES AMOUNT
Cash
Deposits with Lender
Notes & Loans
Payable
[Other Than
Real Estate]
Notes Payable to Banks
Other Banks or Savings & Loans Notes & Loans Payable (Other)
Stocks & Bonds
Marketable Securities
Insurance
Loans
Others
Tax Tax Refund Due Taxes Owed
Insurance Cash Value
Accounts &
Bills Payable
Bank charge Cards
Accounts & Notes
Receivable
Open & Revolving Accounts
Other
Real Estate
Residence(s)
Real Estate &
Notes &
Contracts
Payable
Residence(s)
Unimproved Land Unimproved Land
Income Property(ies) Income Property(ies)
TOTAL REAL ESTATE TOTAL
Other Assets
Other Assets & Personal
Property
Other
Liabilities
TOTAL ASSETS TOTAL LIABILITIES
NET WORTH (Difference between total assets & total liabilities)
RE-CAP OF INCOME AND EXPENSES
ANNUAL INCOME FOR YEAR ANNUAL EXPENSE FOR YEAR CONTINGENT LIABILITIES
Salary or Wages Property Tax & Assessments As Endorser on Notes/Contracts
Dividends or Interest Fed. & State Income Tax As Guarantor on Notes/Contracts
Rentals (Gross Income) Real Estate Loan Payments For Taxes
Business (Net Income) Payments on Contracts/Notes Other (Describe)
Other Income (Describe)* Estimated Living Expenses
Other:
TOTAL INCOME TOTAL EXPENSES TOTAL
* Alimony, child support, and maintenance payment income need not be revealed if you do not wish to have it considered as a basis
for repaying this obligation.
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BONNEVILLE BANK DIRECT CONSUMER LOAN APPLICATION APPLICANT INFORMATION

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Completed 21 April 2021

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