Loan Application

To streamline your loan process, please provide all requested information. When you have completed the application, click the Submit button to send your Loan Application to a Loan Officer. You will receive a response to your request within ten (10) business days.

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself. You must complete the Co-Applicant section about your spouse if:

You live in -OR- the property pledged as Collateral is located in a Community Property State (AZ, CA, ID, LA, NM, NV, TX, WA, WI),
Your spouse will use the account, -OR-
You are relying on your spouse's income as a basis for repayment.

If you are relying on income from alimony, child support or separate maintenance, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Primary Applicant and Co-Applicant sections.

Personal
*Name (First MI Last):
*Social Security Number:
Marital Status:	Married Separated Unmarried (Single - Divorced - Widowed)
*Driver's License Number:		*State
*Date of Birth (mm/dd/yyyy):
Home Phone:	-
Work Phone:	-
*E-mail Address:
Income
*Current Employer:
Income Amount:	$
Income Frequency:

Other Income:	$
Source:
Other Income Frequency:
Note: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.

Personal
Name (First MI Last):
Social Security Number:
Marital Status:	Married Separated Unmarried (Single - Divorced - Widowed)
Driver's License Number:		State:
Date of Birth (mm/dd/yyyy):
Home Phone:	-
Work Phone:	-
E-mail Address:
Street Address:
City, State, Zip:	,

Income
Current Employer:
Income Amount:	$
Income Frequency:

Other Income:	$
Source:
Other Income Frequency:
Note: Alimony, child support or separate maintenance income need not be revealed if you do not consider it as a basis for repaying this obligation.

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 this 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.)