Installment Loan Application - Farm Bureau Bank
Installment Loan Application
Are you a US Citizen?
Yes
No
(If no, you are not eligible for financing with Farm Bureau Bank)
If you intend to apply for joint credit, please check here: Yes
No
(Joint Applicant will be contractually responsible)
Return by: Fax: (210) 637-4811 Mail: Farm Bureau Bank
P.O. Box 33427 San Antonio, TX 78265-9865 or Email: services@
Farm B ureau Inform ation
How did you hear about us?
Ad
Mail
Web
Farm Bureau Agent
(Please check one)
Insert
Email
Other: _______________________
Farm Bureau Membership
Are you a Farm Bureau Member?
Yes
No
Farm Bureau Number: ____________________________________
State of Membership:_________________________
Farm Bureau Agent Referral
Agent Name: ___________________________________________ Agent Referral Number: _______________________
By providing the information, I understand that this Farm Bureau Agent has requested that Farm Bureau Bank, P.O. Box 33427, San Antonio, Texas 78265-9865, extend credit to you. Information pertaining to your application may be shared with this agent in order to assist in the application process. To inquire about the status of your application, you may contact this Farm Bureau Agent or you may contact Farm Bureau Bank directly at (800) 492-3276.
Loan Information
Loan Purpose: Consumer
Business
Type of Loan: Collateral PurposeOther: ____________________
Vehicle Pre-Approval
Motorcycle
New Purchase from Dealer
Recreational Vehicle
Purchase from Individual
All-Terrain Vehicle
Refinance
Boat Purchase from Individual with Lien
Jet-Ski
Snow Mobile
Equipment
Are you trading in a vehicle:
Yes
No If yes, enter your monthly payment amount: $_______________________
Amount Requested: $______________________________
Loan Term Requested:
24 months
36 months
48 months
60 months
72 months
Other: _________
Payment Plan: Automatic Payment: Routing Number: _________________________ Account Number: ____________________________
Coupon Book
First Payment Due Day Requested: ___________________________________________________________________
(Must be between the 1st-28th day of the month)
Whose name(s) will be on the vehicle title? _____________________________________________________________
Collateral Information
Year: ______________ Make: ___________________________ Model: ________________________________________ Mileage: __________________________________________________________________________________________________ Vehicle Identification Number (VIN): __________________________________________________________________________ Body: ____________________________________________________________________________________________________
Applic ant In forma tion
First Name: ________________________________ MI: ______ Last Name:___________________________________________ Business Name: _____________________________________ Business Type: _________________________________________ Business Tax ID Number: ____________________________________________________________________________________ Social Security Number: ________ - ______ - ___________ Date of Birth: ______ /______ /________ (Must be of age to contract) Home Phone: (_____) _____ - _______ Cell Phone: (_____) _____ - _______ Mother's Maiden Name: ________________________ Email Address: _____________________________________________________________________________________________ Drivers License #: _____________________________________ State Issued: __________________________________________
Mailing Address
Address: ______________________________________________________ City: ______________________________________ State: _________________________________________________________ Zip: ______________________________________
Physical Address (If different from Mailing Address)
Address: ______________________________________________________ City: ______________________________________ State: _________________________________________________________ Zip: ______________________________________
Time at Residence: _____ /_____
Years / Months
Type of Residence: Own/Buying
Monthly Rent/Mortgage: $______________________________________________
Rent
Other: ________________________________________________
Employment Information
Do you or a member of your household derive any income from farming or other agricultural interests?
Yes
No
Employment Status:
Employed
Self
Retired/Disabled
Not Employed
Current Employer: ______________________________________________________________ Work Phone: (____) _____-_______
Length of Employment:_____ /_____
Years / Months
Position:__________________________________________________________________
Income Information
Primary Applicant's Income Information
Income: $__________________________ (If self-employed, income less business expenses.)
Monthly
Annually
Other Income & Source
Other Income: $______________________ Source: _______________________
Monthly
Annually
(Your alimony, child support and separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.)
Joint Applicant Information
First Name: ________________________________ MI: ______ Last Name:___________________________________________ Social Security Number: ________ - ______ - ___________ Date of Birth: ______ /______ /________ (Must be of age to contract) Home Phone: (_____) _____ - _______ Cell Phone: (_____) _____ - _______ Mother's Maiden Name: ________________________ Drivers License #: _____________________________________ State Issued: __________________________________________
Mailing Address Same as Applicant's Mailing Address
Address: ______________________________________________________ City: ______________________________________ State: _________________________________________________________ Zip: ______________________________________
Physical Address Same as Applicant's Mailing Address
Required if different from Applicant. Address: ______________________________________________________ City: ______________________________________ State: _________________________________________ Zip: __________________________ Time at Residence: ____ / ____
Years / Months
Joint Employment Information
Employment Status:
Employed
Self
Retired/Disabled
Not Employed
Current Employer: ______________________________________________________________ Work Phone: (____) _____-_______
Length of Employment:_____ /_____
Years / Months
Position:__________________________________________________________________
Joint Applicant's Income Information
Income: $__________________________
Monthly
Annually
(If self-employed, income less business expenses.)
Account Protection Options
Guaranteed Asset Protection (GAP)
Guaranteed Asset Protection (GAP) protects you against financial loss in the event your vehicle is damaged beyond repair (totaled) or stolen and never recovered. GAP eliminates or reduces "out of pocket" expenses for the remaining loan balance after loss settlement. Without GAP you would be responsible for paying the difference between the insurance settlement and the outstanding loan balance. A one-time fee will provide GAP coverage for the life of your Farm Bureau Bank vehicle loan.
Would you like to add Guaranteed Asset Protection?
Yes
No
Major Mechanical Protection (MMP)
Major Mechanical Protection helps you avoid vehicle repair costs not covered by the standard manufacturer warranty. In most cases, this plan eliminates out-ofpocket expenses outside of your deductible. Bottom line, you can save a bundle over other service contacts or equivalent warranties with a Farm Bureau Bank MMP plan. Select yes below and a Farm Bureau Bank representative will contact you with a quote base on the information you provided.
Would you like to add Major Mechanical Protection?
Yes
No
If your loan is approved you may receive an installment loan and a credit card. Certain restrictions apply. If you already have a Farm Bureau Bank (Bank) credit card or another Simple Solutions loan, this loan will be considered an advance on your existing account. By submitting this application, you agree to, and have read the Farm Bureau Member Rewards MasterCard Terms & Conditions, which are available for review at . By submitting this application, you certify that all of the statements in this application are true and correct and are made for the purpose of obtaining credit. You authorize Farm Bureau Bank to obtain and verify additional information, including credit reports from credit reporting agencies. You understand that the Bank will rely on this information in deciding whether or not to grant credit to you and that the Bank may request further information as may be necessary to process your application. You understand that Farm Bureau Bank may access title, registration and lien information from an external source in order to perfect the title on a secured loan. You have read and agree to Farm Bureau Bank's privacy notice and understand that you will receive Farm Bureau Bank's privacy notice with the loan documents, and you may view the privacy notice at any time on the Bank's disclosures page. All terms and conditions are subject to change. _________________________________________________________________________________________________________________________________________________________________________
If the loan purpose is business or farm, you are submitting this application on behalf of the company as its authorized representative and as an individual guarantor of payment. In your individual capacity you (even though you may place a title or other designation next to your signature) unconditionally guarantee and promise to pay to Farm Bureau Bank all indebtedness of the business or farm, at any time, relating to this application, as well as, any extensions, increases, or renewals of that indebtedness. _________________________________________________________________________________________________________________________________________________________________________
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens the account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. MEMBER FDIC, Equal Housing Lender.
Please Sign Below
Applicant's Signature: ___________________________________________ Date: ___________________ Joint Applicant's Signature: _______________________________________ Date: ___________________
ILA_318
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