Fillable CREDIT APPLICATION . IMPORTANT: Please read these directions (National Bank)

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CREDIT APPLICATION . IMPORTANT: Please read these directions (National Bank)

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FOR BANK USE ONLY Rating I/C Initials
APPROVED DISAPPROVED REASON FOR DENIAL
CREDIT APPLICATION
IMPORTANT: Please read these directions before completing this Application, and check ( ) the appropriate box below.
If you are applying for individual credit 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 only Sections A and D. If the requested credit is to be secured, also complete the first part of Section C and Section E.
If you are applying for joint credit with another person, complete all Sections except E, providing information in B about the joint applicant. If the requested credit is to be secured, then complete
Section E.
If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment
of the credit requested, complete all Sections except E to the extent possible, providing information in B about the person on whose alimony, support, or maintenance payments or income on
assets you are relying. If the requested credit is to be secured, then complete Section E.
AMOUNT REQUESTED
$
LOAN TERM
PURPOSE
SECTION A - INFORMATION REGARDING APPLICANT
FIRST NAME
MIDDLE LAST DATE OF BIRTH SOCIAL SECURITY NUMBER
PRESENT STREET ADDRESS APT. #
CITY STATE
ZIP CODE
HOME TELEPHONE NUMBER
( )
HOW LONG AT ADDRESS
YRS. MOS.
OWN RENT OTHER
NO. OF DEPENDENTS
PREVIOUS HOME ADDRESS
ZIP CODESTATE
CITY
HOW LONG AT PREVIOUS ADDRESS
YRS.
MOS.
PRESENT EMPLOYER
PRESENT POSITION HOW LONG WITH EMPLOYER
MOS.
YRS.
GROSS MONTHLY INCOME
$
BUSINESS ADDRESS
ZIP CODESTATECITY
BUSINESS PHONE NO.
( )
Income from alimony, child support or separate maintenance payments need not be revealed if you do not
choose to have it considered as a basis for repaying this obligation.
MONTHLY AMOUNT OF OTHER INCOME
$
SOURCE OF OTHER INCOME
PREVIOUS EMPLOYER (OR SCHOOLATTENDED)
POSITION
CITY/STATE HOW LONG
MOS.YRS.
$
GROSS MONTHLY INCOME
NAME OF NEAREST RELATIVE NOT LIVING WITH YOU
CITYADDRESS STATE PHONE NO.
( )
Is any income listed in this Section likely to be reduced before the credit requested is paid off? yes no
Explain
Checking Account No. Where?
Savings Account No. Where?
SECTION B - INFORMATION REGARDING JOINT APPLICANT OR OTHER PARTY (use separate sheets if necessary)
FIRST NAME
MIDDLE LAST DATE OF BIRTH SOCIAL SECURITY NUMBER
PRESENT STREET ADDRESS
APT. # CITY STATE ZIP CODE
HOME TELEPHONE NUMBER
( )
RELATIONSHIP TOAPPLICANT (IF ANY)
NO. OF DEPENDENTS
PRESENT EMPLOYER
PRESENT POSITION
HOW LONG WITH EMPLOYER
MOS.
YRS.
GROSS MONTHLY INCOME
$
BUSINESS ADDRESS
ZIP CODESTATECITY BUSINESS PHONE NO.
( )
Income from alimony, child support or separate maintenance payments need not be revealed if you do not
choose to have it considered as a basis for repaying this obligation.
MONTHLY AMOUNT OF OTHER INCOME
SOURCE OF OTHER INCOME
PREVIOUS EMPLOYER (OR SCHOOLATTENDED)
POSITION
CITY/STATE
MOS.YRS.
HOW LONG
$
GROSS MONTHLY INCOME
Is any income listed in this Section likely to be reduced before the credit requested is paid off? yes no
Explain
Checking Account No. Where?
Savings Account No. Where?
SECTION C - MARITAL STATUS (do not complete if this is an Application for individual unsecured credit?
Applicant Married Separated Unmarried (including single, divorced and widowed)
Other Party Married Separated Unmarried (including single, divorced and widowed)
CONTINUED ON REVERSE
.
SECTION D - ASSET & DEBT INFORMATION
If Section B has been completed, this Section should be completed, giving information about both the Applicant and Other Applicant. Please mark Applicant-related information with an "A".
If Section B was not completed, only give information about the Applicant in this Section.
ASSETS OWNED (Use separate sheet if necessary)
DESCRIPTION OF ASSETS
VALUE
SUBJECT TO DEBT? NAME OF OWNERS
CASH
$
AUTOMOBILES (Make, Model, Year)
yes no
PERSONAL PROPERTY
yes no
CASH VALUE OF LIFE INSURANCE
(Issuer, Face Value)
yes no
REAL ESTATE (Location, Date Acquired)
yes no
MARKETABLE SECURITIES (Issuer, Type, Number of Shares)
yes no
OTHER (List)
yes no
TOTAL ASSETS
$
OUTSTANDING DEBTS (include installment contract, credit cards, rent, mortgages, etc., use separate sheet if necessary)
CREDITOR
TYPE OF DEBT
OR ACCOUNT #
NAME IN WHICH
ACCOUNT IS CARRIED
ORIGINAL
DEBT
PRESENT
BALANCE
MONTHLY
PAYMENTS
PAST DUE
LANDLORD OR MORTGAGE HOLDER
RENT PAYMENT
MORTGAGE
$
(Omit Rent)
$
(Omit Rent)
$
(Include Rent)
yes no
yes no
yes no
yes no
yes no
yes no
TOTAL DEBTS
$ $ $ yes no
Total Income: _____________________ Total Monthly Debt Service ($): ___________________ Total Debt Ratio, Including New Loan: _________________ (Gross / Net)
Collateral Value: ________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
Are you a comaker, endorser, or guarantor on any loan or contract? yes no If yes: For whom? ________________________ To whom? ________________________
Are there any unsatisfied judgements against you? yes no If yes: Amount $ ___________________ To whom owed? ____________________________________
Have you been declared bankrupt in the last 14 years? yes no If yes: Where? ________________________________ Year? ______________________
Other Obligations (For example, liability to pay alimony, child support, separate maintenance. Use separate sheet if necessary)
SECTION E - SECURED CREDIT (Complete only if credit is to be secured) Briefly describe the property to be given as security:
Property Description or Auto Description
My Auto Insurance Agent is: (Name & Address)
Name and Addresses of all Co-owners of the Property
If the Security is Real Estate, Give the Full Name of Your Spouse (if applicable)
I have applied for an extension of credit with you.You are soliciting, offering, or selling me an insurance product 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 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 from an unaffiliated entity. By signing below, I acknowledge that I have received a
copy of this form on today’s date. Unless I have applied for credit by mail, I also acknowledge that you have provided this disclosure to me orally.
SIGNATURES
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 (If applicable) Date
IL-1 Rev. 8/08
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CREDIT APPLICATION . IMPORTANT: Please read these directions (National Bank)

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Completed 27 December 2021

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