Installment Loan Application - Farm Bureau Bank

[Pages:3]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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