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Consumer Loan Application

I. TYPE OF LOAN

Purpose of Loan *

Purchase Price *

Describe Other Purpose *

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Loan Amount *

Collateral Offered *

Collateral Description *

Intended Use *

Collateral Address *

Collateral Town/City *

Collateral State *

Collateral County *

Term *

Select all that apply *

Will any of the loan proceeds be used to purchase a mobile home?

Will any of the loan proceeds be used to repair, remodel or improve a mobile home?

Will any of the loan proceeds be used to refinance an existing loan that is secured by a mobile home?

II. APPLICANT INFORMATION

Account *

Individual

Joint

Applicant Name *

Social Security Number *

Date of Birth * +

Address *

City *

State *

ZIP *

County *

Primary Phone *

Email *

Marital Status *

Married

Separated

Unmarried-single,divorced,widowed

Co-Applicant *

Co-Applicant: Name *

Co-Applicant: SSN *

Co-Applicant: DOB * +

Same as Borrower's Address *

Yes

No

Co-Applicant: Address *

Co-Applicant: City *

Co-Applicant: State *

Co-Applicant: ZIP *

Co-Applicant: County *

Co-Applicant: Primary Phone *

Co-Applicant: Email *

Co-Applicant: Marital Status *

Married

Separated

Unmarried-single,divorced,widowed

Is your mailing address different than your present address? *

Yes

No

Mailing Address *

City *

State *

ZIP *

III. EMPLOYMENT/INCOME INFORMATION

Borrower Employment Type *

Employed (full-time/part-time)

Self-Employment

I do not have employment income

Co-Borrower Employment Type *

Employed (full-time/part-time)

Self-Employment

I do not have employment income

*Self Employed Applicant(s) may be required to provide additional documentation such as tax returns and financial statements.

Employer Name & Address

Business Phone

Years Employed

Position/Title & Type of Business

Income

How often

Co-Applicant Employer Name & Address

Co-Applicant: Business Phone

Co-Applicant: Years Employed

Co-Applicant: Position/Title & Type of Business

Co-Applicant: Income

Co-Applicant: How often

NOTICE: 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.

Other Income

Amount

How often

Applicant

Co-Applicant

Other Income

Amount

How often

Applicant

Co-Applicant

IV. HOUSING INFORMATION

Own

Rent

Monthly Housing

Since

Present Value

V. ASSETS

Checking & Savings Accounts

1) Account Type

Bank Name/Account Number

Balance

2) Account Type

Bank Name/Account Number

Balance

3) Account Type

Bank Name/Account Number

Balance

4) Account Type

Bank Name/Account Number

Balance

5) Account Type

Bank Name/Account Number

Balance

6) Account Type

Bank Name/Account Number

Balance

Stocks and Bonds

Do you have stocks or bonds? *

Yes

No

Company Name/Number

Face Value

Cash Value

Company Name/Number

Face Value

Cash Value

Company Name/Number

Face Value

Cash Value

Life Insurance-Face Value

Vested Interest in Retirement Funds

Automobiles Owned

Make and Model

Year

Value

Make and Model

Year

Value

Make and Model

Year

Value

Real Estate Owned

1) Property Address

Type of Property

Market Value

Amount of Mortgage

Mortgage Payment

2) Property Address

Type of Property

Market Value

Amount of Mortgage

Mortgage Payment

3) Property Address

Type of Property

Market Value

Amount of Mortgage

Mortgage Payment

4) Property Address

Type of Property

Market Value

Amount of Mortgage

Mortgage Payment

VI. LIABILITIES

List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc.

1) Company Name & Account #

Loan Type

Balance

Months Left

Monthly Payment

2) Company Name & Account #

Loan Type

Balance

Months Left

Monthly Payment

3) Company Name & Account #

Loan Type

Balance

Months Left

Monthly Payment

4) Company Name & Account #

Loan Type

Balance

Months Left

Monthly Payment

5) Company Name & Account #

Loan Type

Balance

Months Left

Monthly Payment

Alimony/Child Support/Separate Maintenance Payments

Are you required to pay alimony, child support or separate maintenance payments? *

Yes

No

Type

Monthly Amount

Payable to

Applicant

Co-Applicant

Type

Monthly Amount

Payable to

Applicant

Co-Applicant

VII. AUTHORIZATIONS & DISCLOSURES

ELECTRONIC DISCLOSURE AUTHORIZATION

The Electronic Disclosure and Consent contains important information that you are entitled to receive before you consent to transact business with us electronically. Please read this notice and print or download a copy for your files.

Applicant

I have read and agree to accept account disclosures online and affirmatively consent to receive the required disclosures in electronic form, including disclosures required by the Truth in Lending Act, Real Estate Settlement Procedures Act and Equal Credit Opportunity Act. Paper copies will be provided for certain real estate related transactions after your loan application is received. I also agree to receive communications regarding the status of my application electronically via the email address provided with the online application. *

I AGREE to the Electronic Disclosure Authorization

I DO NOT AGREE to the Electronic Disclosure Authorization

Co-Applicant

I have read and agree to accept account disclosures online and affirmatively consent to receive the required disclosures in electronic form, including disclosures required by the Truth in Lending Act, Real Estate Settlement Procedures Act and Equal Credit Opportunity Act. Paper copies will be provided for certain real estate related transactions after your loan application is received. I also agree to receive communications regarding the status of my application electronically via the email address provided with the online application. *

I AGREE to the Electronic Disclosure Authorization

I DO NOT AGREE to the Electronic Disclosure Authorization

CREDIT CHECK AUTHORIZATION

Applicant

I hereby grant permission for you to obtain all information deemed necessary to process your loan application. This information includes, but is not limited to, your past and present employment status, your deposit accounts, your past and present consumer credit record, your mortgage record and/or your rental record. *

I AGREE to the Credit Check Authorization

I DO NOT AGREE to the Credit Check Authorization

Co-Applicant

I hereby grant permission for you to obtain all information deemed necessary to process your loan application. This information includes, but is not limited to, your past and present employment status, your deposit accounts, your past and present consumer credit record, your mortgage record and/or your rental record. *

I AGREE to the Credit Check Authorization

I DO NOT AGREE to the Credit Check Authorization

PATRIOT ACT

Applicant

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: As part of applying for your loan, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. *

I AGREE to the Patriot Act

I DO NOT AGREE to the Patriot Act

Co-Applicant

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: As part of applying for your loan, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. *

I AGREE to the Patriot Act

I DO NOT AGREE to the Patriot Act

MILITARY LENDING ACT

Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to select one of the following statements as applicable.

Warning: It is important to fill out this section accurately. Knowingly making a false statement on a credit application is a crime.

Applicant *

I AM a member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (generally for a period of 180 consecutive days or more).

I AM a dependent of a member of the U.S. Armed Forces on active duty as described above. Dependents include, for example, a member's spouse, a member's child under the age of twenty-one years old, or an individual for whom the member provided more than one-half of the individual's financial support for 180 days immediately preceding today's date.

I AM NOT a regular or reserve member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (or a dependent of such a member).

Co-Applicant *

I AM a member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (generally for a period of 180 consecutive days or more).

I AM a dependent of a member of the U.S. Armed Forces on active duty as described above. Dependents include, for example, a member's spouse, a member's child under the age of twenty-one years old, or an individual for whom the member provided more than one-half of the individual's financial support for 180 days immediately preceding today's date.

I AM NOT a regular or reserve member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (or a dependent of such a member).

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

Ethnicity (check one or more) *

Hispanic/Latino

Not Hispanic/Latino

I do not wish to provide

Hispanic or Latino *

Mexican

Puerto Rican

Cuban

Other Hispanic or Latino

Other Hispanic or Latino - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on *

Race (check one or more) *

Asian *

Native Hawaiian or Other Pacific Islander *

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on *

American Indian or Alaskan Native - Print name of enrolled or principal tribe *

Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on *

Sex *

Female

Male

I do not wish to provide

Co-Borrower

Co-Borrower: Ethnicity (check one or more) *

Hispanic/Latino

Not Hispanic/Latino

I do not wish to provide

Co-Borrower: Hispanic or Latino *

Mexican

Puerto Rican

Cuban

Other Hispanic or Latino

Co-Borrower: Other Hispanic or Latino - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on *

Co-Borrower: Race (check one or more) *

Co-Borrower: Asian *

Co-Borrower: Native Hawaiian or Other Pacific Islander *

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

Co-Borrower: Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on *

Co-Borrower: American Indian or Alaskan Native - Print name of enrolled or principal tribe *

Co-Borrower: Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on *

Co-Borrower: Sex *

Female

Male

I do not wish to provide

NOTICE OF RIGHT TO RECEIVE A COPY OF APPRAISAL

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close. You can pay for an additional appraisal for your own use at your own cost.

Applicant *

I acknowledge receipt of this Notice of Right to Receive a Copy of Appraisal

Co-Applicant *

I acknowledge receipt of this Notice of Right to Receive a Copy of Appraisal

JOINT APPLICATION ACKNOWLEDGMENT

We intend to apply for joint credit. *

Applicant

Co-Applicant

APPLICANT SIGNATURES

I/We hereby apply for the loan or credit described in this application. I/We certify, that I/We made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/We did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purposes. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experience or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. There representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell or any part of the loan. I/We further authorize Lender to provide any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.

Applicant Name *

Co-Applicant Name *

BRANCH & LOAN OFFICER INFORMATION

Preferred Branch Location *

Loan Officer *

How did you learn about us? *

Are you an existing customer? *

Yes

No

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