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Loan Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

The items marked with (*) are required fields.

General Information
Marital Status: Complete marital status if this loan is for:
a. Joint or secured credit, or
b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
emptycheckbox Unmarried
emptycheckbox Married
emptycheckbox Separated
emptycheckbox This application is not for joint or secured credit and I do not live in the states listed above.
*Type of Loan Requested  
*Loan Amount Requested $
*Loan Term Requested  

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Primary Applicant
*Credit Intention I intend to apply for credit.
*Account Number  
*Last Name  
*First Name  
Middle Name  
*Social Security Number (TIN)  
*Date of Birth  
Number of Dependents  
Ages of Dependents  
*Home Phone Number  
Work Phone Number                            ext.
emptycheckbox Cell emptycheckbox Phone emptycheckbox Pager emptycheckbox Other Phone Number                            ext.
Email Address  
Drivers License #  
Drivers License State  
Mother’s Maiden Name  
Home Address
*Address 1  
Address 2  
*City  
*State  
*Zip  
Time at Current Residence               Years               Months
Residence Type emptycheckbox Own emptycheckbox Rent emptycheckbox Other
Monthly Payment $
Previous Address
Address 1  
Address 2  
City  
State  
Zip  
Time at Previous Residence               Years               Months
Residence Type emptycheckbox Own emptycheckbox Rent emptycheckbox Other
Present Employer
Name  
Phone Number ext.
Employment Status emptycheckbox Full Time emptycheckbox Part Time emptycheckbox Temp emptycheckbox Retired emptycheckbox Other
Job Title  
Job Start Date  
Gross Salary $                   Per emptycheckbox Year emptycheckbox Month emptycheckbox Hour
Alimony, child support, or separate maintenance income need not be revealed
if you do not wish to have it considered as a basis for repaying this obligation.
Other Income $                   Per emptycheckbox Year emptycheckbox Month emptycheckbox Hour
Other Income Source  
Previous Employer
Name  
Phone Number ext.
Employment Status emptycheckbox Full Time emptycheckbox Part Time emptycheckbox Temp emptycheckbox Retired emptycheckbox Other
Job Title  
Job Start Date  
Job End Date  
Gross Salary $                               Per emptycheckbox Year emptycheckbox Month emptycheckbox Hour

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Co-Applicant
Credit Intention I intend to apply for credit.
Account Number  
Last Name  
First Name  
Middle Name  
Social Security Number (TIN)  
Date of Birth  
Number of Dependents  
Ages of Dependents  
Home Phone Number  
Work Phone Number                           ext.
emptycheckbox Cell emptycheckbox Phone emptycheckbox Pager emptycheckbox Other Phone Number                           ext.
Email Address  
Drivers License #  
Drivers License State  
Home Address
Address 1  
Address 2  
City  
State  
Zip  
Time at Current Residence               Years               Months
Residence Type emptycheckbox Own emptycheckbox Rent emptycheckbox Other
Monthly Payment $
Previous Address
Address 1  
Address 2  
City  
State
Zip  
Time at Previous Residence               Years               Months
Residence Type emptycheckbox Own emptycheckbox Rent emptycheckbox Other
Present Employer
Name  
Phone Number ext.
Employment Status emptycheckbox Full Time emptycheckbox Part Time emptycheckbox Temp emptycheckbox Retired emptycheckbox Other
Job Title  
Job Start Date  
Gross Salary $                   Per emptycheckbox Year emptycheckbox Month emptycheckbox Hour
Alimony, child support, or separate maintenance income need not be revealed
if you do not wish to have it considered as a basis for repaying this obligation.
Other Income $                   Per emptycheckbox Year emptycheckbox Month emptycheckbox Hour
Other Income Source  
Previous Employer
Name  
Phone Number ext.
Employment Status emptycheckbox Full Time emptycheckbox Part Time emptycheckbox Temp emptycheckbox Retired emptycheckbox Other
Job Title  
Job Start Date  
Job End Date  
Gross Salary $                   Per emptycheckbox Year emptycheckbox Month emptycheckbox Hour

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References
Nearest relative Not Living With You
Last Name  
First Name  
Relationship  
emptycheckbox Cell emptycheckbox Phone emptycheckbox Pager emptycheckbox Other Phone Number                           ext.
Address 1  
Address 2  
City  
State  
Zip  

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Debts/Monthly Payments
List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan.
Debts Monthly Payments
Credit Card $
  $
  $
  $
  $
  $
  $
  $
  $
  $
  $

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Secured Credit
Complete only if credit is to be secured. Briefly describe the property to be given as security.
Property Description
If vehicle, please complete.
Color  
Model  
Plate No.  
Names and addresses of all co-owners of the property.

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Additional Information
How would you prefer to be contacted?
emptycheckbox Home Phone
emptycheckbox Work Phone
emptycheckbox Cell Phone
emptycheckbox Email Address
emptycheckbox Other

Which office would you like to close your loan at?
emptycheckbox St. Francis
emptycheckbox Blaine
emptycheckbox Anoka-Ramsey
emptycheckbox East Bethel

Special Instructions/Comments

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Income verification is required; other information may be required.

I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)