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Consumer Loan Application

Loan Information

Loan Type(Required)

Amount Requested(Required)

Loan Term(Required)

APPLICANT(S) Check one of the following boxes. You may apply for individual credit in your name only, or joint credit in your name and the name(s) of other joint applicant(s).

Individual Credit

Joint Credit

We intend to apply for joint credit

Applicant Initials(Required)

Co-Applicant Initials(Required)

Loan Purpose

To be secured by collateral?

Yes

No

If yes, describe collateral.

Year

Make

Model

Mileage

VIN/SN

Personal Information

Name(Required)

First Last

Social Security Number(Required)

Birth Date(Required)

Marital Status

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Previous Mailing Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Contact / Reference Person

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Housing Information

Length of Residence(Required)

Select Months / Years(Required)

Select Housing Status(Required)

Monthly Payment(Required)

Mortgage Holder

($) Estimated Property Value

Mortgage Balance

Employment Information

Employer

Telephone Number

Supervisor

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Position / Department

Length of Employment

($) Income

Select Increment

Previous Employer

Company Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Financial Information

Do you have a Checking Account?

Yes

No

If yes, where?

Value?

Do you have a Savings Account?

Yes

No

If yes, where?

Value?

Other Debt Information

Other Debt Information

Type of Debt (Car Loan, Credit Cards)

Balance

Monthly Payment

Declarations

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

Yes

No

Are you a co-signer, endoser or guarantor on any loan or contract?

Yes

No

If yes, for whom?

To whom?

Are there any unsatisfied judgments against you?

Yes

No

Have you ever declared bankruptcy?

Yes

No

If yes, where? (City, State)

What year?

Additional Comments

Please Note: Alimony, child support, or maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation. Submission of this form authorizes Patrons Bank NA to verify information provided herein, including but not limited to employment and credit history.

Do you need to fill out co-applicant information?(Required)

Yes

No

Select Relationship to Applicant

Name(Required)

First Last

Social Security Number(Required)

Birth Date(Required)

Select Marital Status

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email

Contact / Reference Person

Name(Required)

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Housing Information

Length of Residence(Required)

Select Months/ Years(Required)

Select Housing Status(Required)

($) Monthly Payment

Mortgage Holder

($) Estimated Property Value

($) Mortgage Balance

Employment Information

Employer

Telephone Number

Supervisor

Address

Street Address City State / Province / Region ZIP / Postal Code

Position / Department

Length of Employment

($) Income

Select Increment

Previous Employer

Company Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Other Debt Information

Other Debt Information

Type of Debt (Car Loan, Credit Cards)

Balance

Monthly Payment

Declarations

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

Yes

No

Are you a co-signer, endorser or guarantor on any loan or contract?

Yes

No

If so, for whom?

To whom?

Are there any unsatisfied judgments against you?

Yes

No

Have you ever declared bankruptcy?

Yes

No

IF yes, where (city, state)

What year?

Additional Comments

Please Note: Alimony, child support, or maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.
Notice to married applicant: No provision of a marital property agreement, a unilateral statement under Wis. Stat. sec 766.59 or a court decree under Wis. Stat. sec 766.70 adversely affects the interests of the bank unless prior to the time the credit is extended, the bank is furnished with a copy of the agreement statement or decree, or has actual knowledge of the adverse provision when the obligation to the bank is incurred.
Submission of this form authorizes Patrons Bank NA to verify information provided herein, including but not limited to employment and credit history.

Important Information About Procedures for Opening a New Account

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 opens an account.
What this means for you: When you 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.
You will be required to come into one of our locations to complete the loan process. (Sign loan papers, verify information, etc.)

Federal Credit Application Insurance Disclosure

Insurance Disclosure

I agree to accept Patrons Bank NA's Federal Credit Application Insurance Disclosure electronically.

I would like to receive Patrons Bank NA's Federal Credit Application Insurance Disclosure by mail.

I certify that everything I have stated in this application and on any attachments is correct. Patrons Bank NA may keep this application whether or not it is approved. By signing below I authorize Patrons Bank NA to check my credit and employment history and to answer questions others may ask Patrons Bank NA about my credit record with Patrons Bank NA. I understand that I must update credit information at Patrons Bank NA's request if my financial condition changes.

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