CONSUMER LOAN APPLICATION

CONSUMER LOAN APPLICATION

Branch Office

You need not reveal income from alimony, child support or maintenance payments from a spouse if you do not wish to disclose such income in applying for this credit, but if you do choose to disclose such income or are relying on such income as a basis for repayment of the credit please indicate such source and furnish the requested information below concerning your spouse or former spouse. If you are relying on community property (Texas being a community property state) or your spouses income as a basis of repayment of credit or if your spouse will be contractually liable (co-sign) for this loan furnish information on your spouse.

You have the right to apply for credit separately from or jointly with another person: IF YOU INTEND TO APPLY FOR JOINT CREDIT, PLEASE INITIAL HERE

Applicant

Co-applicant

I hereby apply to Austin Bank for the following loan:

Amount Requested Purpose of Loan

Collateral Offered

Application Date

Applicant's Name

Date of Birth

Social Security #

US Citizen

Resident Alien

Non-resident Alien

Married

Unmarried

Separated

Number of Dependants

Home Phone

Cell Phone

EMAIL

DL #

DL State

DL Issue Date

DL Exp Date

Present Street Address

Mailing Address

Time at Residence

Mortgage Holder/Landlord

Own

Buying Rent

Monthly mortgage/rent payment

Market Value if own

Previous Address

Personal References (2 relatives NOT living with you)

Name

Relationship Address

Phone Number

1

2

Employer

Occupation/Title

Employed

Years

Months

Monthly Income

Net

Gross

Employer Address

Work Phone

Other Income:

Source:

Previous Employer Debts Owed To

Monthly payment

Have you filed bankruptcy?

NO

YES

If yes, year filed

Chapter

Co-Applicant's Name

Date of Birth

Social Security #

US Citizen

Resident Alien

Non-resident Alien

Married

Unmarried

Separated

Dependants

Relationship to borrower

Home Phone

Cell Phone

EMAIL

DL #

DL State

DL Issue Date

DL Exp Date

Street Address

Mailing Address

Time at Residence

Mortgage Holder/Landlord

Own Buying

Rent

Monthly mortgage/rent payment

Market Value if own

Previous Address Personal References (2 relatives NOT living with you)

Name

Relationship Address

Phone #

1

2

Employer

Occupation/Title

Employed

Years

Months

Monthly Income

Net

Gross

Employer Address

Work Phone

Other Income:

Source:

Previous Employer Debts Owed To

Monthly payment

Have you filed bankruptcy?

NO

YES

If yes, year filed

Chapter

I/we owe the debts described herein and none other and affirm and represent that each of the answers to the foregoing questions are true and correct. I/we authorize you to contact creditors and employers of mine/our past or present, obtain reports from credit bureaus and make any other inquiries you deem necessary in connection with this credit application or in the course of collection of any credit granted in reliance on my/our application.

Applicant's Signature & Date Signed

Co-Applicant's Signature & Date Signed

Member

FDIC

Revised August 2009

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