Consumer Loan Application › 1st United Bank

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What type of credit are you requesting? *

Secured

Unsecured

Open-end line of credit

Closed-end term loan

Application Type *

Individual (own income or assets)

Individual (own income or assets plus income or assets from other sources)

Joint

Cosigner

Loan Amount *

Interest Rate

Term *

Payment

Purpose *

Applicant/Cosigner Information

Last Name *

First Name *

Middle Initial

Suffix

Taxpayer ID Number (SSN/TIN) *

Date of Birth *

Street Address *

City *

State *

Zip Code *

County

How Long There?

Driver's License / ID Number

State

Home Phone *

Cell Phone *

Number of Dependents

Age of Dependents

Previous Address (if less than 2 years at current address)

City *

State *

Zip Code *

How Long There?

Employer *

Address

Phone

Position

How Long There *

Pay $ *

Average Monthly Overtime Pay $ *

How often Paid *

Weekly

Monthly

Type of Payment *

Net Pay

Gross Pay

Previous Employer

Position

How Long There?

Previous Employer's Address

Nearest Relative (not living with you)

Relationship

Relative's Phone

Street Address

City

State

Zip Code

Present Mortgage Holder/Landlord *

Phone

Monthly Payment *

Type: *

Own

Rent

Immigration Status:

U.S. Citizen

Permanent Resident of U.S.

Other

If Other, Please Explain

Marital Status:

Married

Separated

Unmarried (including single, divorced, and widowed)

Other Income: Amount $ *

Frequency *

Source

Alimony, Child Support, Separate Maintenance Payments

You are not required to disclose income from alimony, child support, or separate maintenance payments. However, if you are relying on income from alimony, child support or separate maintenance payments as a basis for repayment of this obligation. Please complete the information below.

Payment Received Pursuant to:

Court Order

Written Agreement

Oral Understanding

Alimony per Month $

Child Support per Month $

Separate Maintenance Payments per Month $

Co-Applicant Information

Last Name *

First Name *

Middle Initial

Suffix

Taxpayer ID Number (SSN/TIN) *

Date of Birth *

Street Address *

City *

State *

Zip Code *

County

How Long There?

Driver's License / ID Number

State

Home Phone *

Cell Phone *

Number of Dependents

Age of Dependents

Previous Address (if less than 2 years at current address)

City *

State *

Zip Code *

How Long There?

Employer *

Address

Phone

Position

How Long There *

Pay $ *

Average Monthly Overtime Pay $ *

How often Paid *

Weekly

Monthly

Type of Payment *

Net Pay

Gross Pay

Previous Employer

Position

How Long There?

Previous Employer's Address

Nearest Relative (not living with you)

Relationship

Relative's Phone

Street Address

City

State

Zip Code

Present Mortgage Holder/Landlord *

Phone

Monthly Payment *

Type: *

Own

Rent

Immigration Status:

U.S. Citizen

Permanent Resident of U.S.

Other

If Other, Please Explain

Marital Status:

Married

Separated

Unmarried (including single, divorced, and widowed)

Other Income: Amount $ *

Frequency *

Source

Alimony, Child Support, Separate Maintenance Payments

Payment Received Pursuant to:

Court Order

Written Agreement

Oral Understanding

Alimony per Month $

Child Support per Month $

Separate Maintenance Payments per Month $

Additional Information

If you, a joint applicant, or any other party answers "yes" to any of the following questions, please explain in the space provided.

Are you a guarantor or co-maker of any leases, contracts, or debts?

Applicant: *

Yes

Joint Applicant/ Other Party: *

Yes

To Whom Owed?

Are there any suits or judgements pending against you?

Applicant: *

Yes

Joint Applicant/ Other Party: *

Yes

To Whom Owed? *

Amount $ *

Have you been declared bankrupt in the last 10 years?

Applicant: *

Yes

Joint Applicant/ Other Party: *

Yes

Where *

Year *

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

If the Security is Real Estate, give the full name of your spouse (if any)

Current Assets

Checking Account Number(s)

Where

Owner Name

Value

Subject to Lien:

Yes

Savings Account Number(s)

Where

Owner Name

Value

Subject to Lien: *

Yes

Certificate of Deposit

Where

Owner Name

Value

Subject to Lien: *

Yes

Marketable Securities

Issuer, type, no. of shares

Owner Name

Value

Subject to Lien: *

Yes

Real Estate

Where

Owner Name

Value

Subject to Lien: *

Yes

Life Insurance

Issuer, Face Value

Owner Name

Value

Subject to Lien: *

Yes

Automobiles

Make, model, year

Owner Name

Value

Subject to Lien: *

Yes

Other (list)

Description

Owner Name

Value

Subject to Lien: *

Yes

Total Asset from Addendum

Description

Owner Name

Value

Subject to Lien: *

Yes

TOTAL ASSETS

Description

Owner Name

Value

Subject to Lien: *

Yes

Applicant Code

Name of Creditor

Account Number

Original Amount

Current Balance

Monthly Payment

Pay from proceeds?

Applicant Code

Name of Creditor

Account Number

Original Amount

Current Balance

Monthly Payment

Pay from proceeds?

Applicant Code

Name of Creditor

Account Number

Original Amount

Current Balance

Monthly Payment

Pay from proceeds?

Applicant Code

Name of Creditor

Account Number

Original Amount

Current Balance

Monthly Payment

Pay from proceeds?

Applicant Code

Name of Creditor

Account Number

Original Amount

Current Balance

Monthly Payment

Pay from proceeds?

Applicant Code

Name of Creditor

Account Number

Original Amount

Current Balance

Monthly Payment

Pay from proceeds?

Signature of Applicant or Co-Signer *

Date *

Signature of Co-Applicant *

Date Signed

Notice Provided:

Yes

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