Secure Loan Application

I/We are applying for a loan with Citizens State Bank of New Castle

Primary Borrower Information

Loan Information

Date of this Application:

Amount of Loan Request($):

I am applying for individual credit in my own name and I am relying on my own income and assets and not the income or assets of another person:

I am applying for individual credit and I am relying on my income or assets, as well ass income or assets from other sources:

We are applying for Joint Credit:

Vehicle Information

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Co-Borrower

Name:

Social Security Number:

- -

Date of Birth:

/ /

Home Phone:

Cell Phone:

Email:

Employer:

How Long:

Years on Job Months on Job

Employer Phone:

Income (Gross Or NET):

Income Type:

Weekly Bi-Weekly Monthly

How Long at current Job:

Other Income:

Source of Other Income:

Weekly/Bi-Weekly or Monthly:

Weekly Bi-Weekly Monthly

LIST A RELATIVE OR FRIEND WHO HAS KNOWN YOU FOR 5 YEARS OR MORE

Name:

Address:

City:

State:

Phone Number:

Signature of Applicant / Joint Applicant

Borrower Signature:

write your initials

Date:

/ /

Co-Borrower Signature:

write your initials

Date:

/ /

By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer’s privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I acknowledge I am authorizing this dealer to check my credit.

I/We are applying for a loan with Citizens State Bank of New Castle

Primary Borrower Information

Loan Information

Vehicle Information

Borrower

Co-Borrower

LIST A RELATIVE OR FRIEND WHO HAS KNOWN YOU FOR 5 YEARS OR MORE

Signature of Applicant / Joint Applicant

Co-borrower Information