| Will there be a co-applicant on this loan application? |
Yes No |
| Type of loan requested (Please click the appropriate
box) |
Agricultural Auto Commercial Consumer Real Estate
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| Amount Requested |
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| For
what purpose are you applying for this loan? (Please provide
as much detail as possible.) |
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Primary Applicant
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| Member Number |
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| Social Security Number |
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| Date of Birth |
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| Last Name |
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| First Name |
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| Address |
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| City |
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| State |
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| Zip |
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| Phone |
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| Email |
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| Employer |
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| Job
Title |
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| Employer's Phone |
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| Job
Start Date |
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| Gross Income (per year) |
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| Other Income |
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| Source of other Income |
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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.
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Joint Applicant (if
applicable)
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| Member Number |
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| Social Security Number |
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| Date of Birth |
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| Last Name |
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| First Name |
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| Address |
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| City |
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| State |
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| Phone |
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| Email |
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| Employer |
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| Job
Title |
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| Employer's Phone |
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| Job
Start Date |
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| Gross Income (per year) |
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| Other Income |
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| Source of other Income |
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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. |
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| Monthly Financial
Obligations |
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| In addition to rent or mortgage,
list all other debts (for example, auto loans, credit cards,
second mortgage, home assoc. dues, alimony, child support,
child care, medical utilities, auto insurance, IRS liabilities,
etc.). Please use a separate line for each credit card and
auto loan.
Please note: Income verification
is required; other information may be required.
Complete for Mortgage Loans Only
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, 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.
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- Required field |
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