Consumer Loan Application

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Consumer Loan Application

Loan Request Amount* $

For how many months?*

Loan Purpose*

Auto Purchase Overdraft Protection Other Vehicle Purchase Other

Type of Application*

Individual credit Joint credit

Auto Make

Auto Model

Auto Year

Other Vehicle Type

Explain Other Loan Purpose

Marital Status

Married Separated Unmarried

If you select Married, you may apply for separate or joint credit. Unmarried includes single, divorced, and widowed.

List the number of people dependent on you for financial support:

Applicant Information

Name*

First Name

Last Name

Social Security Number*

Date of Birth*

Driver's License*

State of Driver's License Issued*

State

Home Phone*

Cell Phone

Residence:

Own Rent Parents Other

Present Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Explain Other Residence

Previous Address (if less than 2 years current)

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Time At Present Address*

Years and Months

Time At Previous Address

Years and Months

Employer's Name*

Employer's Address

Address Line 1

Address Line 2

City

State

ZIP Code

Type of Business

Position/Title*

Work E-mail

Work Phone

Time With Employer*

Years and Months

Gross Monthly Income* $

Do you intend to rely on spouse's earnings to qualify for this loan?

Yes No

If yes, your spouse also may be required to sign the promissory note

Other Income (Per Month) $

Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.

Source of Other Income

Do you have a Previous Employer (if less than 3 years at current)

Yes No

Name of Previous Employer

Previous Employer Address

Address Line 1

Address Line 2

City

State

ZIP Code

Previous Employer Phone

Position With Previous Employer

Time With Previous Employer

Years and Months

Joint Applicant or Other Party Information

Name*

First Name

Last Name

Social Security Number*

Date of Birth*

Driver's License

State of Driver's License Issued

State

Gross Monthly Income $

Other Income (Per Month) $

Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.

Source of Other Income

Employer's Name

Employer's Address

Address Line 1

Address Line 2

City

State

ZIP Code

Type of Business

Position/Title

Work E-mail

Work Phone

Time With Employer

Years and Months

Do you have a Previous Employer (if less than 3 years at current)

Yes No

Name of Previous Employer

Previous Employer Address

Address Line 1

Address Line 2

City

State

ZIP Code

Previous Employer Phone

Position With Previous Employer

Time With Previous Employer

Years and Months

Bank References

Bank Name

Bank Address

Address Line 1

Address Line 2

City

State

ZIP Code

Checking Account Number

Savings Account Number

Do you have a second bank references?

Yes No

Bank Name (2nd)

Bank Address (2nd)

Address Line 1

Address Line 2

City

State

ZIP Code

Checking Account Number (2nd)

Savings Account Number (2nd)

Home Information

First Mortgage Holder Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Purchase Date of House

Purchase Price $

Estimated Current Value of Property $

Balance Owing $

Mortgage Number

Monthly Mortgage Payment $

Rental Information

Landlord

Rental Address

Address Line 1

Address Line 2

City

State

ZIP Code

Starting Rental Date

Monthly Rental Payment $

Credit Reference

List all debts, including second mortgage.
Provide additional documentation if needed.

Lender Name

Lender Address

Address Line 1

Address Line 2

City

State

ZIP Code

Account Number

Original Loan Amount $

Original Loan Balance $

Monthly Payment Towards Loan $

Add a second credit reference?

Yes No

Credit Reference (2nd)

Lender Name (2nd)

Lender Address (2nd)

Address Line 1

Address Line 2

City

State

ZIP Code

Account Number (2nd)

Original Loan Amount (2nd) $

Loan Balance (2nd) $

Monthly Payment Towards Loan (2nd) $

Add a third credit reference?

Yes No

Credit Reference (3rd)

Lender Name (3rd)

Lender Address (3rd)

Address Line 1

Address Line 2

City

State

ZIP Code

Account Number (3rd)

Original Loan Amount (3rd) $

Loan Balance (3rd) $

Monthly Payment Towards Loan (3rd) $

Add a fourth credit reference?

Yes No

Credit Reference (4th)

Lender Name (4th)

Lender Address (4th)

Address Line 1

Address Line 2

City

State

ZIP Code

Account Number (4th)

Original Loan Amount (4th) $

Loan Balance (4th) $

Monthly Payment Towards Loan (4th) $

Have you or your Joint Applicant:

Declared Bankruptcy?*

Yes No

Had a Judgment?*

Yes No

Had a repossession or foreclosure?*

Yes No

If yes to any of the above, please explain:

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your First Community Bank checking or savings account?

Yes No

Account Number

Automatically transferred funds will be applied as my monthly payment on each monthly due date so long as there are adequate funds on deposit or there is available credit in my account, until the loan is paid or the Bank receives written notice to cancel. I understand the Bank reserves the right to terminate the automatic repayment plan without notice. Please initial your request:

Please initial your request:

Agreement/Signature

I certify that all information provided by me is true, correct and complete. I authorize First Community Bank to make whatever inquires about me you deem necessary and appropriate for the purposes of evaluating my credit application. including credit reports and contacting my employer. I also authorize First Community Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies.

Applicant Signature*

Applicant Signature Date*

Joint Applicant Signature

Joint Applicant Signature Date

Consumer Loan Application

Marital Status

Applicant Information

Joint Applicant or Other Party Information

Bank References

Home Information

Rental Information

Credit Reference

List all debts, including second mortgage. Provide additional documentation if needed.

Credit Reference (2nd)

Credit Reference (3rd)

Credit Reference (4th)

Have you or your Joint Applicant:

Automatic Loan Payment

Agreement/Signature

List all debts, including second mortgage.
Provide additional documentation if needed.