Consumer Loan Inquiry Citizens First Bank

Date

Purpose / Type of Loan

CONSUMER LOAN

Amount Requested

Number of Payments (number of months)

Preferred Payment Day (mm/dd/yyyy)

Collateral offered:

*Description of Collateral Offered:

BORROWER INFORMATION

(If borrower is married, he/she/ they may apply for individual credit

*Social Security Number:(Required)

*Date of Birth (mm/dd/yyyy)(Required)

*Home Phone(Required)

Cell Phone

Email(Required)

Driver’s License Number

Expiration Date

LENGTH AT RESIDENcE

Years(Required)

Months(Required)

Monthly Payment

BORROWER EMPLOYMENT INFORMATION

*Current Employer(Required)

*Position/ Title/ Type of Business(Required)

TIME AT THIS JOB

Years(Required)

Months(Required)

*Gross monthly Income

Years employed in this line of work

Employer’s Phone Number

ABOUT YOUR EXISTING AccOUNTS

Bank / S & L / Credit Union Name:

Checking Account #

Savings Account #

Bank / S & L / Credit Union Name:

Checking Account #

Savings Account #

Bank / S & L / Credit Union Name:

Checking Account #

Savings Account #

BORROWER OTHER INcOME (if any)

NOTICE: Alimony, child support, or separate maintenance income need not be revealed by you if you do not wish to have it considered as a basis of repayment. You may reveal this type of income if you do wish to have it considered as source of repayment.

Source:

Description:

Amount:

Frequency:

Source:

Description:

Amount:

Frequency:

Source:

Description:

Amount:

Frequency:

QUESTIONS

I/We hereby apply for the loan or credit described in this application. I/We certify that I/we made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.

WE INTEND TO APPLY FOR JOINT cREDIT

AMOUNT REQUESTED

FOR HOW LONG

PAYMENT DATE DESIRED

PROcEEDS OF JOINT LOAN TO BE USED FOR:

JOINT BORROWER INFORMATION

JOINT APPLICANT BIRTHDAY

JOINT APPLICANT TELEPHONE NUMBER

JOINT APPLICANT SOCIAL SECURITY NUMBER

JOINT APPLICANT DRIVER'S LICENSE NO.

JOINT BORROWER EMPLOYMENT INFORMATION

*JOINT APPLICANT CURRENT EMPLOYER

*Position/ Title/ Type of Business

JOINT APPLICANT Salary Per Month

JOINT APPLICANT Years employed in this line of work

Sources of Other Income

BORROWER AcKNOWLEDGEMENT

Borrower

Initials

Signature

Date (mm/dd/yyyy)

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING AN ACCOUNT WITH CITIZENS FIRST BANK. Section 326 of the USA PATRIOT ACT requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. This federal requirement applies to all new customers. This information is used to assist the United States government in the fight against the funding of terrorism and money-laundering activities. What this means to you: when you open an account, we will ask each person for their name, physical address, mailing address, date of birth, and other information that will allow us to identify them. We will ask to see each person’s driver's license and other identifying documents and copy or record information from each of them.

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CONSUMER LOAN INQUIRY