Following is the suggested information needed for online consumer loan requests-NOT to be used for real estate-secured loan requests.

 
CHOOSE ONE:
 

Individual Borrower: I am applying for individual credit relying only on my own income or assets and not another person as a basis for repayment.

Joint Applicant/Borrowers: We intend to apply for joint credit.

Applicant: Clicking acknowledges consent I Agree

Co-Applicant: Clicking acknowledges consent I Agree

Individual Borrower: I will be 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.

 
LOAN REQUEST:
   
Amount Requested:
 
Proceeds of Credit to be Used For:
 
Collateral Offered (Note: See Real Estate Loans for requests secured by real estate.)
 
APPLICANT:
 

Marital Status: Check one: Married Separated Unmarried (single, divorced, widowed) Do not complete if this is an Application for individual unsecured credit.

 
Name (Last, First, Middle):
 
Birth Date:
 
Home Phone:
 
Business Phone & Ext:
 
Social Security No.:
 
No. Dependents and Ages:
 
Residential Address:
 
How Long:
 
Previous Address:
 
How Long:
 
Present Employer (Company Name):
 
Present Employer (Address):
 
Occupation:
 
How Long with Present Employer:
 
Present Gross Salary or Commission: $ per
 
Previous Employer (Company Name):
 
Previous Employer (Address):
 
Dates of This Previous Employment:
 

Alimony, child support, or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Alimony, child support, or separate maintenance received under: Court Order
Written Agreement or Oral Understanding

 
Other Income:
 
Source of Income:
 
Is any income listed above likely to be reduced before the credit request is paid off: Yes No
 
Name of Nearest Relative Not Living With You:
 
Relationship:
 
Address: Telephone No:
 
 
INFORMATION REGARDING JOINT APPLICANT OR OTHER PARTY:
 

Marital Status: Check one: Married Separated Unmarried (single, divorced, widowed) Do not complete if this is an Application for individual unsecured credit.

 
Name (Last, First, Middle):
 
Birth Date:
 
Home Phone:
 
Business Phone & Ext:
 
Social Security No.:
 
No. Dependents and Ages:
 
Residential Address:
 
How Long:
 
Previous Address:
 
How Long:
 
Present Employer (Company Name):
 
Present Employer (Address):
 
Occupation:
 
How Long with Present Employer:
 
Present Gross Salary or Commission: $ per
 
Previous Employer (Company Name):
 
Previous Employer (Address):
 
Dates of This Previous Employment:
 

Alimony, child support, or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Alimony, child support, or separate maintenance received under: Court Order
Written Agreement or Oral Understanding

 
Other Income:
 
Source of Income:
 
Is any income listed above likely to be reduced before the credit request is paid off: Yes No
 
Name of Nearest Relative Not Living With You:
 
Relationship:
 
Address: Telephone No:
 

Outstanding Debts (also include credit cards, installment contracts, alimony, child support, etc.)

 

If applying jointly, include information about both the Applicant and Joint Applicant or Other Person.

 
Landlord or Mortgage Holder:
 
Present Balance:$ Monthly Payment:$
 
Past Due?: Yes      No
 
Other Debts: Please list other loans, credit cards, etc. with balances and required payments.
 

Are either of you a comaker, endorser, or guarantor on any loan or contract?
Yes       No

 
If Yes, for whom? To Whom?
 

Are there any unsatisfied judgments against you?
Yes       No

 
If Yes, Amount? $ To Whom Owed?
 

Have you been declared bankrupt in the last 10 years?
Yes      No

 
If Yes, Where? Year?
 

IMPORTANT INSURANCE DISCLOSURE

 

Credit life and accident and health insurance are not deposits and are not insured by the Federal Deposit Insurance Corporation (FDIC) or other agency of the United States Government. They are not insured by the First National Bank & Trust Co. of Junction City and loan approval will not be conditioned on either of the following: (1) Your purchase of an insurance product or annuity from us or any of our affiliates; or, (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.

 

Everything that I/we have stated in this application is correct to the best of my knowledge. I/we understand that you will retain this application whether or not it is approved. You are authorized to check my/our credit and employment history and answer questions about your credit experience with me/us. I/we hereby acknowledge that I/we have reviewed the Important Insurance Disclosure above. I/we understand that I/we can print and retain a copy of this disclosure if I/we so choose.

 
My Email Address:
 
 
 
   

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