Name
Address
Apt. No.
City
State
Zip
*
Email
How long at residence?
*
Social Security No.
Home Phone
Date of Birth
Employer
Position
Employer Address
How long employed?
Previous Employer
How Long?
Gross Monthly Income?
Purpose of Loan Request
Mortgage Loan
Auto Loan
Consolidation
Home Equity Loan
Home Improvement
College
Other
Checking Account Overdraft Protection
Amount Requested $
Months requested to repay
Co-Application Information:
Name
Social Security No.
Employer Phone
Position
How Long?
Gross Monthly Income
$
Creditors
Balance
Monthly Payments
1.
$
$
2.
$
$
3.
$
$
4.
$
$
5.
$
$
*
Total Monthly Installment Payments:
(excluding mortgage payments)
$
*
Monthly Mortgage or Rent $
Own
Rent
Live with Relatives
Have you ever taken bankruptcy?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Have you ever received credit from us?
Yes
No
I/We hereby certify that I understand that this is an application for credit and that the information given in this application is true, correct and complete; I/We also understand that submitting this request, I/We authorize Taylor County Bank to conduct such credit inquiries as may be deemed necessary to investigate and confirm my/our stated income, liabilities, credit history and financial condition; and I/We hereby consent to the disclosure and release of the information sought by such inquiries.
*Required Field
Please contact me by:
E-Mail
Telephone
U.S. Mail
