credit application


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CREDIT APPLICATION IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law. TYPE OF CREDIT REQUESTED FOR CREDITOR USE IMPORTANT: Check ( ) the appropriate boxes below and complete the applicable sections. DATE CLASS NO. INDIVIDUAL CREDIT - relying solely on my income or assets SECURED ACCOUNT NO. INDIVIDUAL CREDIT - relying on my income or assets as well as income or assets from UNSECURED other sources APPROVED BY

l l l

l l

DECLINED

JOINT CREDIT - We intend to apply for joint credit. (initials)

AMOUNT REQUESTED

FOR HOW LONG

PAYMENT DATE DESIRED

WANT TO REPAY

l l

$

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BY

PROCEEDS OF LOAN TO BE USED FOR:

MONTHLY

SECTION A - INDIVIDUAL APPLICANT INFORMATION NAME (Last, First, Middle) TELEPHONE NO.

BIRTHDATE

DRIVER'S LICENSE NO.

SOCIAL SECURITY NO.

NO. DEPENDENTS

l l Did you l or l

COUNTY

ADDRESS (Street, City, State & Zip)

AGES OF DEPENDENTS

Do you or

COUNTY

PREVIOUS ADDRESS (Street, City, State & Zip) (Complete if less than 3 years at present address)

own HOW LONG rent? own HOW LONG rent?

EMPLOYER (Company Name & Address) BUSINESS PHONE

Ext.

HOW LONG POSITION OR TITLE

SALARY PER MONTH GROSS: $

NET: $

PREVIOUS EMPLOYER (Company Name & Address)

HOW LONG

NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU

RELATIONSHIP

TELEPHONE NO. (Include Area Code)

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony, child support, separate maintenance received under: SOURCES OF OTHER INCOME

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Court Order

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Written Agreement

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Oral Understanding AMOUNT PER MONTH

Is any income listed in this Section likely to be reduced before the credit request is paid off?

$ Have you previously received credit from us?

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l

No

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Yes (Explain)

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No

Yes - When?

SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION

Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state. NAME (Last, First, Middle) TELEPHONE NO.

BIRTHDATE

RELATIONSHIP TO APPLICANT (If Any)

DRIVER'S LICENSE NO.

SOCIAL SECURITY NO.

NO. DEPENDENTS

AGES OF DEPENDENTS HOW LONG

PRESENT ADDRESS (Street, City, State & Zip)

HOW LONG

EMPLOYER (Company Name & Address) BUSINESS PHONE

Ext.

POSITION OR TITLE

SALARY PER MONTH GROSS: $

NET: $ HOW LONG

PREVIOUS EMPLOYER (Company Name & Address) Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony, child support, separate maintenance received under:

l

Court Order

l

Written Agreement

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Oral Understanding

SOURCES OF OTHER INCOME

AMOUNT PER MONTH

Is any income listed in this Section likely to be reduced before the credit requested is paid off?

$ Has Joint Applicant or Other Party ever received credit from us?

l

l

No

l

Yes (Explain)

Credit Application VMP , Bankers Systems * Wolters Kluwer Financial Services

-1986, 2006

No

l

Yes - When?

Initials:

UCA 2/9/2007 VMPC148 (0612) Page 1 of 3

Military Lending Act Statement Federal law provides important protections to members of the Armed Forces and their dependents relating to extensions of consumer credit. In general, the cost of consumer credit to a member of the Armed Forces and his or her dependent may not exceed an annual percentage rate of 36 percent. This rate must include, as applicable to the credit transaction or account: The costs associated with credit insurance premiums; fees for ancillary products sold in connection with the credit transaction; any application fee charged (other than certain application fees for specified credit transactions or accounts); and any participation fee charged (other than certain participation fees for a credit card account).

To hear this statement read to you, please call 1-800-722-0427, and choose option number five.