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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