Consumer Loan Application

Important Information

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 an account.  What this means for you When you open an account, or apply for a loan, we will ask 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.

This application is designed to be completed by the applicant (s) with the lender's assistance. Please indicate whether you intend to apply for individual or joint credit.  Applicants for joint credit should complete the applicable co-borrower sections of the application. Co-borrower information must be provided when the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification, or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the secured property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

You must be a U. S. Citizen with a U.S. address and Social Security number to apply online. Our lending area is Fayette County, Texas and adjoining counties, all other applicants should contact us at 979-968-3136.

Type of Credit Requested

IMPORTANT: Check the appropriate boxes below and complete the applicable sections.*
SECURED
UNSECURED
INDIVIDUAL CREDIT - relying solely on my income or assets.
JOINT CREDIT

*
AMOUNT REQUESTED*
$
FOR HOW LONG
PAYMENT DATE DESIRED
WANT TO REPAY
Monthly
Other
PROCEEDS OF LOAN TO BE USED FOR*

SECTION A - INDIVIDUAL APPLICANT INFORMATION

NAME (Last, First Middle)*
PHONE*
EMAIL*
 
S.S. NUMBER*
DATE OF BIRTH
NO. DEPENDENTS
DEPENDENT AGES
ADDRESS
CITY
STATE
ZIP CODE
COUNTY
DO YOU
Own Rent
HOW LONG
 

EMPLOYER (Company Name & Address)*
HOW LONG
BUSINESS PHONE*
EXT.
POSITION/TITLE
SALARY PER MONTH
Gross: $

Net: $
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:
Court Order   Written Agreement   Oral Understanding
 
SOURCES OF OTHER INCOME
AMOUNT PER MONTH
$
HAVE YOU PREVIOUSLY RECEIVED CREDIT FROM US?
 

WHEN:

SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION*

NAME (Last, First Middle)
PHONE
EMAIL*
S.S. NUMBER
ADDRESS
CITY
STATE
ZIP CODE
 
EMPLOYER (Company Name & Address)
BUSINESS PHONE

SECTION C - MARITAL STATUS*

APPLICANT Married Separated Unmarried (including single, divorced, and widowed)

OTHER PARTY Married Separated Unmarried (including single, divorced, and widowed)

Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable):

Are you obligated to make Alimony, Support or Maintenance Payments? No Yes
If yes, to (Name & Address):     Amt. Per Month: $

Are you a co-maker, endorser, or guarantor on any loan or contract? No Yes   
If yes:   For whom?    To whom?

Are there any unsatisfied judgments against you? No Yes   
If yes, to whom?     Amount: $

Have you been declared bankrupt in the last 10 years? No Yes   
If yes, where?     Year

SECTION D - SECURED CREDIT 

Complete only if credit is to be secured. Briefly describe the property to be given as security:

PROPERTY DESCRIPTION

NAME & ADDRESS OF ALL CO-OWNERS OF THE PROPERTY

FEDERAL CREDIT APPLICATION INSURANCE DISCLOSURE: I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance product or annuity in connection with this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING THE EXTENSION OF CREDIT ON EITHER: 1) My purchase of an insurance product or annuity from your or from any of your affiliates; 2) My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity. By signing, I acknowledge that I have received a copy of this form on today's date. Unless this disclosure is provided electronically or I have applied for credit by mail, I also acknowledge that you have provided this disclosure to me orally.

I CERTIFY that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By clicking the "Submit" button below, I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.