Consumer Loan Application

Loan Information

Requested Loan Amount

Today's Date

Purpose of Loan

Applicant Information

If you are a Wisconsin resident indicate marital status

Unmarried

Legally Separated

Married

First Name

MI

Last Name

Date of Birth

Social Security Number

Number of Dependents

Address Line 1

Address Line 2

City

State

ZIP

Number of Years Here

County You Live In

Phone Number

Previous Address

Please note, if you've been at your current address for less than two years, this field is required in order to have your application reviewed.

Address Line 1

Address Line 2

City

State

ZIP

Current Employer

Phone Number

Address Line 1

Address Line 2

City

State

ZIP

How Long Have You Been at This Employer (Years and Months)

Position

Monthly Income, Pay, Salary, Commission, Gross

Monthly Income, Pay, Salary, Commission, Net

Please note, if you've been at your current employer for less than two years, you are required to provide the following information.

Previous Employer

How long were you at this employer (years and months)?

Address Line 1

Address Line 2

City

State

ZIP

Name of Nearest Relative Not Living with You

Phone number

Address Line 1

Address Line 2

City

State

ZIP

Have you previously been extended credit under other names? If so, what names?

Have you ever been sued for debt? Yes No

Have you ever been a debtor in bankruptcy proceedings? Yes No

If you answered yes to either of the last two questions, please explain.

Current Checking Account #

Financial Institution Where you Have this Account

Current Savings Account #

Financial Institution Where you Have this Account

Spouse Information

Relationship to applicant

Co-Applicant (Joint Credit)

Non-Applicant

First Name

MI

Last Name

Date of Birth

Social Security Number

Number of Dependents

Address Line 1

Address Line 2

City

State

ZIP

Number of Years Here

County You Live In

Phone Number

Previous Address - Please enter even if same as applicant's previous address

Please note, if you have been at your current address less than two years, it is required you fill in this information for your application to be processed.

Address Line 1

Address Line 2

City

State

ZIP

Current Employer

Phone Number

Address Line 1

Address Line 2

City

State

ZIP

How Long Have You Been at This Employer (Years and Months)

Position

Monthly Income, Pay, Salary, Commission, Gross

Monthly Income, Pay, Salary, Commission, Net

Please note, if you have been at your current employer for less than two years, it is required you provide the following information.

Previous Employer

How long were you at this employer (years and months)?

Address Line 1

Address Line 2

City

State

ZIP

Name of Nearest Relative Not Living with You

Phone number

Address Line 1

Address Line 2

City

State

ZIP

Have you previously been extended credit under other names? If so, what names?

Spouse: Have you ever been sued for debt? Yes No

Spouse: Have you ever been a debtor in bankruptcy proceedings? Yes No

If you answered yes to either of the last two questions, please explain.

Current Checking Account #

Financial Institution Where you Have this Account

Current Savings Account #

Financial Institution Where you Have this Account

Other Income

Please tell us about any other INCOME for the primary APPLICANT. Income such as alimony, child support or maintenance need not be revealed if you are not relying on these funds to repay this loan.

If you don't have any additional income to report, simply enter '0' and 'N/A' in the fields below.

Other Monthly Income - Amount in dollars

Other Income Source

Please tell us about any other INCOME for the applicant's SPOUSE. Income such as alimony, child support or maintenance need not be revealed if you are not relying on these funds to repay this loan.

If there is no additional income to report, simply enter '0' and 'N/A' in the fields below.

Other Monthly Income - Amount in dollars

Other Income Source

Credit References

Mortgage / Rent Information

Mortgage Holder / Landlord Name

Address Line 1

Address Line 2

City

State

ZIP

Resident Applicant Spouse

Approximate Value

Balance Owed

Monthly Mortgage or Rent

Auto Loan Information

Auto #1

Year of Auto #1

Make and Model of Auto #1

Financed by

Address Line 1

Address Line 2

City

State

ZIP

Owner or Loan Holder of Auto 1 Applicant Spouse

Purchase Price

Balance Owed

Monthly Payment

Auto 2

Year of Auto #2

Make and Model of Auto #2

Financed by

Address Line 1

Address Line 2

City

State

ZIP

Owner or Loan Holder of Auto 2 Applicant Spouse

Purchase Price

Balance Owed

Monthly Payment

Credit Card Information

Visa Account Information

Visa Account Number

Credit Limit

Visa Cardholder: Applicant Spouse

Balance Owed

Monthly Payment

Mastercard Account Information

Master Card Account Number

Credit Limit

Mastercard Cardholder: Applicant Spouse

Balance Owed

Monthly Payment

Additional Credit Card #1

This can be another Visa or Master Card or store / company card.

Company

Address Line 1

Address Line 2

City

State

ZIP

Additional Card 1 Cardholder Applicant Spouse

Account Number

Credit Limit

Balance Owed

Monthly Payment

Additional Credit Card #2

This can be another Visa or Master Card or store / company card.

Company

Address Line 1

Address Line 2

City

State

ZIP

Credit Card 2 Cardholder Applicant Spouse

Account Number

Credit Limit

Balance Owed

Monthly Payment

Additional Credit Card #3

This can be another Visa or Master Card or store / company card.

Company

Address Line 1

Address Line 2

City

State

ZIP

Additional Card 3 Cardholder Applicant Spouse

Account Number

Credit Limit

Balance Owed

Monthly Payment

Additional Credit Card #4

This can be another Visa or Master Card or store / company card.

Company

Address Line 1

Address Line 2

City

State

ZIP

Additional Credit Card 4 Cardholder Applicant Spouse

Account Number

Credit Limit

Balance Owed

Monthly Payment

Other Payment Obligations

Obligations for Alimony

Obligations for Alimony Responsible Party Applicant Spouse

Monthly Payment

Child Support

Child Support Responsible Party Applicant Spouse

Monthly Payment

Maintenance Payments

Maintenance Payments Responsible Party Applicant Spouse

Monthly Payment

Other Payments

Other Payments Responsible Party Applicant Spouse

Monthly Payment

Acknowledgment

By checking below, you agree to these statements:

NOTICE TO MARRIED APPLICANTS RESIDING IN WISCONSIN: No provisions of any marital property agreement, unilateral statement under Se. 766.59 Wis.Stats., or court degree under sec.766.70 adversely affects the interest of the creditor unless the creditor, prior to the time credit is granted, is furnished a copy of the agreement, statement or decree of has actual knowledge of the adverse provision when the obligation to creditor is incurred.

For the purposes of obtaining the credit described above, and any future credit granted to the undersigned by the creditor named above, the undersigned, jointlly and severally, represent that the above statements are true and complete, authorize the creditor named above, or its agents, to verify them and obtain additional information concerning our credit standing and furnish the same to others, and gree to the provisions of any rules, regulations or agreets of the creditor named above governing such credit. This application is creditor's property.

I agree to the above statement. Yes

Instructions

Mortgage / Rent Information

Auto Loan Information

Auto #1

Auto 2

Visa Account Information

Mastercard Account Information

Additional Credit Card #1

Additional Credit Card #2

Additional Credit Card #3

Additional Credit Card #4

Obligations for Alimony

Child Support

Maintenance Payments

Other Payments