Auto and Personal Loan Application Form

Applicant

First Name *

Middle Initial

Last Name *

Suffix

Social Security Number *

Birth Date *

Home Address *

City *

State *

Zip Code *

Primary Phone Number *

Work Phone Number

Email Address *

How would you prefer to be contacted? * Primary Phone Work Phone Email Other

Applicant Employment *

Employed Not Employed

Have you worked here for more than 2 years? * Yes No

Income Information

Number of Dependents

Other Monthly Income

Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.

Credit Information

Have you ever declared bankruptcy? * Yes No

Have you ever had a judgment? * Yes No

Have you ever had a repossession or foreclosure? * Yes No

Please explain

Automatic Loan Payment

Do you want your monthly payment automatically deducted from your First Security Bank checking or savings account? Yes No

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize First Security Bank to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize First Security Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Auto and Personal Loan Application Form

Auto & Personal Loan Application Form

Loan Information

Vehicle Loan Information

Applicant

Applicant Employment *

Income Information

Credit Information

Automatic Loan Payment

Endorsement