Submitter Information(Required)
First
Last
Consent(Required) We intend to apply jointly.
Type of Credit Requested Type of Loan(Required)
Contact Information How Would You Prefer to be Contacted?(Required) When is the best time to arrange an appointment?(Required)
First Applicant Personal Information Name(Required)
First
Middle
Last
Email(Required)
First Applicant Current Address Home Address Not a P.O. Box(Required)
Home Status(Required)
First Applicant Previous Address Previous Address Not a P.O. Box
First Applicant Dependent and Relative Information: Relative Address Not a P.O. Box
First Applicant Current Employer Employers Address(Required)
First Applicant Previous Employer Previous Employers Address
Alimony, child support, separate maintenance income received under:*(Required) 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? Marital Status
First Applicant Asset & Debt Information - Checking Account Checking Bank Address
Is this Account Subject to Debt?
First Applicant Asset & Debt Information - Savings Account Savings Bank Address
First Applicant Asset & Debt Information - Certificate of Deposit Certificate of Deposit Bank Address
First Applicant Asset & Debt Information - Marketable Securities Assets
First Applicant Asset & Debt Information - Real Estate Assets Real Estate Address
First Applicant Asset & Debt Information - Life Insurance Assets
First Applicant Asset & Debt Information - Automobile Assets
First Applicant Asset & Debt Information - Other Assets
First Applicant Asset & Debt Information - Rent or Mortgage Payment Rent or Mortgage Payment
First Applicant Asset & Debt Information - Automobile Debt
First Applicant Asset & Debt Information - Other Debt
First Applicant Secured Credit Co-Owner Address
Co-Applicant Personal Information Name(Required)
First
Middle
Last
Email(Required)
Co- Applicant Current Address Same as first applicant?(Required) Home Address Not a P.O. Box
Home Status
Co-Applicant Previous Address Same as first applicant?(Required) Previous Address Not a P.O. Box
Co-Applicant Dependent and Relative Information: Same as first applicant?(Required) Relative Address Not a P.O. Box
Co-Applicant Current Employer Employers Address
Co-Applicant Previous Employer Previous Employers Address
Alimony, child support, separate maintenance income received under:* 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? Marital Status
Co- Applicant Asset & Debt Information - Checking Account Same as first applicant?(Required) Checking Bank Address
Is this Account Subject to Debt?
Co- Applicant Asset & Debt Information - Savings Account Same as first applicant?(Required) Savings Bank Address
Co-Applicant Asset & Debt Information - Certificate of Deposit Same as first applicant?(Required) Address
Co-Applicant Asset & Debt Information - Marketable Securities Assets Same as first applicant?(Required)
Co-Applicant Asset & Debt Information - Real Estate Assets Same as first applicant?(Required) Address
Co-Applicant Asset & Debt Information - Life Insurance Assets Same as first applicant?(Required)
Co-Applicant Asset & Debt Information - Automobile Assets Same as first applicant?(Required)
Co-Applicant Asset & Debt Information - Other Assets Same as first applicant?(Required)
Co-Applicant Asset & Debt Information - Rent or Mortgage Payment Same as first applicant?(Required) Rent or Mortgage Payment
Co- Applicant Asset & Debt Information - Automobile Debt Same as first applicant?(Required)
Co-Applicant Asset & Debt Information - Other Debt Same as first applicant?(Required)
Co-Applicant Secured Credit Same as first applicant?(Required) Address
Consent(Required) I agree to the Applicant(s) Statement, below.
Applicant(s) Statement
By clicking Submit below, I/we certify that everything stated in this application is correct. Flanagan State Bank may keep this application whether or not it is approved. By submitting this application I/we authorize Flanagan State Bank to check my/our credit and employment history and to answer questions others may ask Flanagan State Bank about my credit record with Flanagan State Bank. I/we understand that I/we must update credit information at the request of Flanagan State Bank if my financial condition changes.