Loan Application


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* Upon approval, at which branch would you like to finalize your account documentation?
Will there be a co-applicant on this loan application? Yes or No
* Amount requested
* Purpose
Security
If applicable - Description of Collateral Vehicle: Make, Model and Year
* Length of Loan
* Credit Type
Personal Information
* Name:
*Social Security Number:
*Driver's License Number:
State Issued:
Expiration Date:
* Birthdate:
* Home Address:
* City:
* State:
* Zip:
How Long?
* Home Phone Number:
* Email Address:
If you've lived at your current address less than 2 years, please provide your previous home address:
Previous Home Address:
City:
State:
Zip:
* Name of nearest relative not living with you:
Relationship:
Home Address:
City:
State:
Zip:
Employment Information
Work Phone Number:
* Employer name:
* Address:
* City:
*State:
* Zip:
* Position:
* Gross Monthly Income:
* How Long Employed:
Other income
Note: 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.
Declarations
* Are you obliged to make alimony, support or maintenance payments?
If yes, to whom:
Name:
Address:
City:
State:
Zip:
Amount per Month:
* Are you a comaker, endorser or guarantor on any loan or contract?
If yes, for whom:
To whom:
* Are there any unsatisfied judgments against you?
If yes, to whom owed:
Amount:
* Have you ever declared bankruptcy?
If yes, where (city, state):
What year:
Asset Information
Savings/Checking balance
Real Estate
(locations, value)
Auto - year, make, model
Other Asset
Debt Information

List all debts and credit accounts, replacing "Other" with description. If those listed do not apply, please say "None" for  balance & payment..

Rent or Mortgage
Credit Card
Auto Payments
Joint or Other Applicant Information

If your loan application is for joint credit, for individual credit relying on income or assets from other sources, you must also fill out this section of the application.  

If you are applying for individual credit, you can skip this section. 

Name:
Social Security Number:
Driver's License Number:
State Issued:
Expiration Date:
Birth date
Home Address:
City:
State:
Zip:
How Long?
Home Phone Number:
If you've lived at your current address less than 2 years, please provide your previous home address:
Previous Home Address:
City:
State:
Zip:
Name of nearest relative not living with you:
Relationship:
Home Address:
City:
State:
Zip:
Employment Information
Work Phone Number:
Employer name:
Address:
City:
State:
Zip:
Position:
Gross Monthly Income:
How Long Employed:
Source of other income
Note: 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.
Amount per month:
Any comments or questions you may have for us?
Any comments or questions you may have for us?

By submitting this application, I/We certify that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize Bank of Dudley to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for, or for any other services offered. This application does not constitute a contract for the extension of credit.

INSURANCE DISCLOSURE FOR CREDIT APPLICATION

Purpose

In connection with your loan application, Lender may be soliciting, offering to sell, or will sell you an insurance product or annuity. Federal law requires Lender to provide you with the following disclosures.

Credit Disclosures

  1. Lender, as a condition of granting you a loan, cannot require that you purchase an insurance product or annuity from Lender or any of its affiliates.
  2. Lender, as a condition of granting you a loan, cannot require your agreement not to obtain or prohibit you from obtaining an insurance product or annuity from an unaffiliated entity

Acknowledgment

* I ACKNOWLEDGE THAT I HAVE READ, RECEIVED AND UNDERSTAND THIS INSURANCE DISCLOSURE.



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