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Couple looking at a new home

Loan Application

 
*Indicates a Required Field

Credit Request Info

Type of Credit Requested *

Primary Applicant

Own or Rent? *Primary Applicant
Own or Rent? Primary Applicant Previous Address

Primary Applicant Employment Info

Primary Applicant - Other Income

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.

Alimony, child support, separate maintenance received under: Primary Applicant
Is any income listed above likely to be reduced before the credit requested is paid off? Primary Applicant

Primary Applicant Other Info

Have you ever received credit from us? *Primary Applicant

Primary Applicant Nearest Relative Info

Joint/Other Applicant

Own or Rent? Joint/Other Applicant
Own or Rent? Joint/Other Applicant Previous Address

Joint/Other Applicant Employment Info

Joint/Other Applicant - Other Income

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.

Alimony, child support, separate maintenance received under: Joint/Other Applicant
Is any income listed above likely to be reduced before the credit requested is paid off? Joint/Other Applicant

Joint/Other Applicant Other Info

Have you ever received credit from us? Joint/Other Applicant

Joint/Other Applicant Nearest Relative Info

Asset and Debt Information

Assets Owned

Checking Account(s)

Checking Account 1
Is Checking Account 1 Subject to Debt?
Checking Account 2
Is Checking Account 2 Subject to Debt?
Checking Account 3
Is Checking Account 3 Subject to Debt?
Checking Account 4
Is Checking Account 4 Subject to Debt?
Checking Account 5
Is Checking Account 5 Subject to Debt?

Savings Accounts

Savings Account 1
Is Savings Account 1 Subject to Debt?
Savings Account 2
Is Savings Account 2 Subject to Debt?
Savings Account 3
Is Savings Account 3 Subject to Debt?
Savings Account 4
Is Savings Account 4 Subject to Debt?
Savings Account 5
Is Savings Account 5 Subject to Debt?

Certificate(s) of Deposit

Certificate of Deposit 1
Is Certificate of Deposit 1 Subject to Debt?
Certificate of Deposit 2
Is Certificate of Deposit 2 Subject to Debt?
Certificate of Deposit 3
Is Certificate of Deposit 3 Subject to Debt?
Certificate of Deposit 4
Is Certificate of Deposit 4 Subject to Debt?
Certificate of Deposit 5
Is Certificate of Deposit 5 Subject to Debt?

Real Estate

Real Estate 1
Is Real Estate 1 Subject to Debt?
Real Estate 2
Is Real Estate 2 Subject to Debt?
Real Estate 3
Is Real Estate 3 Subject to Debt?
Real Estate 4
Is Real Estate 4 Subject to Debt?
Real Estate 5
Is Real Estate 5 Subject to Debt?

Marketable Securities

Marketable Security 1
Is Marketable Security 1 Subject to Debt?
Marketable Security 2
Is Marketable Security 2 Subject to Debt?
Marketable Security 3
Is Marketable Security 3 Subject to Debt?
Marketable Security 4
Is Marketable Security 4 Subject to Debt?
Marketable Security 5
Is Marketable Security 5 Subject to Debt?

Life Insurance

Life Insurance 1
Is Life Insurance 1 Subject to Debt?
Life Insurance 2
Is Life Insurance 2 Subject to Debt?
Life Insurance 3
Is Life Insurance 3 Subject to Debt?
Life Insurance 4
Is Life Insurance 4 Subject to Debt?
Life Insurance 5
Is Life Insurance 5 Subject to Debt?

Automobiles

Automobile 1
Is Automobile 1 Subject to Debt?
Automobile 2
Is Automobile 2 Subject to Debt?
Automobile 3
Is Automobile 3 Subject to Debt?
Automobile 4
Is Automobile 4 Subject to Debt?
Automobile 5
Is Automobile 5 Subject to Debt?

Other Assets

Other Asset 1
Is Other Asset 1 Subject to Debt?
Other Asset 2
Is Other Asset 2 Subject to Debt?
Other Asset 3
Is Other Asset 3 Subject to Debt?
Other Asset 4
Is Other Asset 4 Subject to Debt?
Other Asset 5
Is Other Asset 5 Subject to Debt?

Outstanding Debts

include charge accounts, installment contracts, credit cards, mortgage, etc.

Mortgage

Automobile

Other Creditor or Additional Automobile 1

Other Creditor or Additional Automobile 2

Other Creditor or Additional Automobile 3

Other Creditor or Additional Automobile 4

Other Creditor or Additional Automobile 5

Other Creditor or Additional Automobile 6

Total Debts *

Complete the following information about both the Primary Applicant and Joint or Other Applicant (if applicable)
Primary or Joint/Other Applicant, are you obligated to make Alimony, Support or Maintenance payments? *

If yes, please answer the following:

Primary or Joint/Other Applicant, are you a co-maker, endorser, or guarantor on any loan or contract? *
Primary or Joint Applicant, are there any unsatisfied judgments against you? *
Primary or Joint Applicant, have you declared bankruptcy in the past 10 years? *

Secured Credit

Credit Disclosures

An insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity:

(1) The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliates;

(2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the FederaI Deposit Insurance Corporation or any other agency of the United States, this institution, or our affiliates; and

(3) In the case of an insurance product or annuity that involves an investment risk, there is investment risk associated with the insurance product, including the loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following:

(3a) Your purchase of an insurance product or annuity from us or any of our affiliates; or

(3b) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.

By submitting this form, I certify that everything I have stated in this application is correct. Citizens National Bank may keep this application whether or not it is approved. I authorize Citizens National Bank to check my credit and employment history and to answer questions others may ask Citizens National Bank about my credit record. I understand that I must update credit information at the request of Citizens National Bank if my condition changes.

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