Consumer Credit Loan Application

Instructions: Please review this entire form before beginning. You may need to enter data not immediately available. Once the form has been sent, you will not be able to go back and make corrections. We suggest printing your completed form before sending. If you are not applying with a co-applicant, please leave the Co-Applicant section blank. All fields marked with an asterisk (*) are required.

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.

Loan

Type of Credit Requested *


Applicant

Applicant Information

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(Enter ID number from state-issued ID)

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Applicant Address

Please enter your physical home address.

Check this box if your mailing address is different than the address entered above.

Applicant Mailing Address

Enter your mailing address if it is different than your home address.

Applicant Previous Address

Enter your previous address if you have been at current address less than three years.

Applicant Contact Information

Please enter at least one phone number and indicate the number type.

Applicant Housing Status

Applicant Employment

If employed, please fill out the information about applicant employer below.

Have you worked for this employer for more than three years?

If you indicated "less than three years" above, please complete the previous employer section below.

Income Information

Income

Do you plan to rely on the co-applicant's earnings to qualify for this loan?

Marital Status

Complete only if for joint or secured credit, or if applicant resides in joint property state or is relying on property located in such a state as a basis for repayment of the credit request. Note: Wisconsin is a joint property state per Wisconsin Marital Property Act of 1986.

Applicant:

Co-Applicant:

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

Please use this toggle button and complete the co-applicant section if there is a co-applicant for this loan.

Credit and Reference

Bank References

Outstanding Debt

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

Credit Information

Have you or your co-applicant been declared bankrupt in the last ten years? *

Are there any unsatisfied judgments against you or your co-applicant? *

Have you or your co-applicant ever had a repossession or foreclosure? *

Are you obligated to make alimony, support or maintenance payments?


Automatic Loan Payment

Automatic Deduction

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

Notice to Married Applicants: No provision of any marital property agreement, unilateral statement under Wisc. Statues §766.59 or a court decree under Wisc. Statues §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

Signature

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Farmers State Bank to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Farmers State Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I agree to provide any further information the Bank might require to process my application.

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