• Important Information to Applicant(s) . To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who applies for a loan or opens an account.

  
  

  What this means for you. When you apply for a loan or open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. 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.

  
  

  Read each instruction carefully before completing this form.

  
  

Type of Application

• Will this be an individual or joint application?
  Individual Credit - relying solely on my income or assets Individual Credit - relying on my income or assets as well as income or assets from other sources Joint Credit - We intend to apply for joint credit

Type of Requested Credit

• Amount Requested *
• Financing Type *
  New Refinance
• For how long? *
• First payment date? *
• Loan Purpose
  Agricultural Business Consumer
• Security for Credit
  Secured Unsecured
• Proceeds of Credit to Be Used for

Individual Applicant Information

• Name(Last, First, Middle) *
• Government ID Type
• Government ID Number
• Government ID Issued By
• Government ID Issue Date
• Government ID Expiration Date
• Birth date *
• Social Security Number *
• Primary Phone Number *
• Secondary Phone Number
• Email Address *
• Street Address *
• City *
• State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip Code *
• County *
• Do you own or rent?
  Own Rent
• Years at Address *
• Have you lived at this address for less than 3 years?
  Yes No

Previous Address

• Street Address
• City *
• State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip Code *
• County *
• Did you own or rent? *
  Own Rent
• Years at Address *

• Number of dependents *
• Age of dependents *
• Name & address of nearest relative not living with you *
• Relationship *
• Telephone number (include area code) *
• Have you previously received credit from us? *
  No Yes
• When? *
• What branch? *

Assets and Debt Information

Assets Owned

• Type of Asset or Description	Account Number	Current Market Value	Remaining Balance of Lien	Asset Owner's Name
  Asset 1	Account 1	$	$	Owner 1
  Asset 2	Account 2	$	$	Owner 2
  Asset 3	Account 3	$	$	Owner 3
  Asset 4	Account 4	$	$	Owner 4
  Asset 5	Account 5	$	$	Owner 5
  Total Assets		$	$

Outstanding Debts

(This section should be charge accounts, installment contracts, credit cards, rent, mortgages and other obligations.)

• Creditor Name	Type of Debt, or Account Number	Original Amount	Present Balance	Monthly Payment	Debtor's Name	Past Due (Yes/No)
  Creditor 1	Account Number 1	$	$	$	Debtor 1	Past Due 1
  Creditor 2	Account Number 2	$	$	$	Debtor 2	Past Due 2
  Creditor 3	Account Number 3	$	$	$	Debtor 3	Past Due 3
  Creditor 4	Account Number 4	$	$	$	Debtor 4	Past Due 4
  Creditor 5	Account Number 5	$	$	$	Debtor 5	Past Due 5
  Creditor 6	Account Number 6	$	$	$	Debtor 6	Past Due 6
  Total Debts		$	$	$

Credit References

Reference 1

• Name
• Original Amount Borrowed
• Date Paid in Full

Reference 2

• Name
• Original Amount Borrowed
• Date Paid in Full

Reference 3

• Name
• Original Amount Borrowed
• Date Paid in Full

Employment Information

• Employer (Company Name & Address) *
• How long? *
• Business Phone *
• Position or Title *
• Gross Monthly Income *
• Net Monthly Income *
• Do you have another employer to add?
  Yes No

• Employer (Company Name & Address) *
• How long? *
• Business Phone *
• Position or Title *
• Gross Monthly Income *
• Net Monthly Income *
• Do you have another employer to add?
  Yes No

• Employer (Company Name & Address) *
• How long? *
• Business Phone *
• Position or Title *
• Gross Monthly Income *
• Net Monthly Income *

• Are you a co-maker, endorser, co-signer, surety, or guarantor on any loan, contract or other obligation?
  Yes No
• If yes, please explain *
• Are there any unsatisfied judgments against you?
  Yes No
• If yes, please explain *
• Have you been declared bankrupt in the last 10 years?
  Yes No
• If yes, please explain *
• Are you obligated to make Alimony, Support or Maintenance Payments?
  Yes No
• If yes, please explain *

Other Income

• *ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT WISH IT TO BE CONSIDERED AS A BASIS FOR REPAYING THIS OBLIGATION.

  
  
• Alimony, child support, separate maintenance under
  Court Order Written Agreement Oral Understanding
• Sources of other income *
• Amount per month
• Is any income listed in this Section likely to be reduced before the credit request is paid off? *
  No Yes
• If so, please explain *

Collateral Information

• Collateral Type
  Boat or Vessel Certificate of Deposit Deposit Account Motor Vehicle
• Collateral Description

Notices

California Residents. Each applicant, if married, may apply for a separate account.

New York Residents. A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or not a report was ordered. If a report was ordered, we will tell you the name and address of the consumer reporting agency that provided the report. Subsequent reports may be ordered or utilized in connection with an update, renewal or extension of credit for which you have applied.

Ohio Residents. The Ohio laws against discrimination require all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Texas Residents. The owner of the homestead is not required to apply the proceeds of the extension of credit to repay another debt except debt secured by the homestead or debt to another lender.

Wisconsin Residents. Notice to Married Applicants. No provision of any marital property agreement, unilateral statement under Wisc. Statutes § 766.59 or a court decree under Wisc. Statutes § 766.70 adversely affects the interests 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.

For Married Wisconsin Residents. The credit being applied for, if granted, will be incurred in the interest of my marriage or family. I understand the Creditor may be required by law to give notice of this transaction to my spouse.

Certifications, Authorizations and Signatures

You certify that everything you have stated in this Credit Application and on any other documents submitted to us are true and correct to the best of your knowledge. You understand that you must update the information contained in this Credit Application if either your financial condition materially changes or we make a request to you orally or in writing. You understand that we will retain this Credit Application whether or not it is approved.

You authorize us to request one or more consumer reports, to check and verify your credit and employment history, and to answer questions others may ask us about our credit experience with you.

You authorize us to contact you using any of the telephone numbers listed on this Credit Application or that you subsequently provide us in connection with your credit account - regardless whether the number we use is assigned to a paging service, cellular telephone service, specialized mobile radio service, other radio common carrier service or any other service for which you may be charged for the call. You further authorize us to contact you through the use of voice, text and email and through the use of prerecorded/artificial voice messages or an automatic dialing device.

• Electronic Signature. If checked, You further agree that you have signed this Credit Application with one or more electronic signatures. You intend your electronic signature to have the effect of your written ink signature. You viewed and read the entire Credit Application and notices before you signed it. You understand that this Credit Application is in the electronic form that we will keep. We may rely on, and enforce, this Credit Application in the electronic form or as a paper version of the electronic form.*