Mortgage Loans
Consumer Loan
Credit Card
Consumer Loans
CONSUMER LOAN CREDIT APPLICATION
Type of Credit Requested
IMPORTANT: Check the appropriate boxes below below and complete the applicable sections.
SECURED
UNSECURED
INDIVIDUAL CREDIT - relying solely on my income or assets
INDIVIDUAL CREDIT - relying solely on my income or assets as well as income or assets from other sources
JOINT CREDIT - We intend to apply for joint credit - initials
FOR CREDITOR USE
Date
Class No
Account No.
Approved
By
Denied
AMOUNT REQUESTED
FOR HOW LONG
PAYMENT DATE DESIRED
WANT TO REPAY
MONTHLY
ANNUALLY
PROCEEDS OF LOAN TO BE USED FOR
SECTION A - INDIVIDUAL APPLICANT INFORMATION
NAME (Last, First, Middle)
BIRTHDATE
TELEPHONE NUMBER
DRIVERS LICENSE NUMBER
SOCIAL SECURITY NUMBER
NUMBER OF DEPENDENTS
AGE OF DEPENDENTS
ADDRESS (Street, City, State, Zip)
COUNTY
DO YOU OWN OR RENT
Own
Rent
HOW LONG
PREVIOUS ADDRESS (Street, City, State, Zip)
(Complete if less than 3 years at present address)
COUNTY
DO YOU OWN OR RENT
Own
Rent
HOW LONG
EMPLOYER (Company Name & Address)
HOW LONG
BUSINESS PHONE
EXT
POSITION OR TITLE
SALARY PER MONTH
GROSS: $
NET: $
PREVIOUS EMPLOYER (Company Name & Address)
HOW LONG
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
RELATIONSHIP
TELEPHONE NUMBER (Include Area Code)
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, or separate maintenance received under
Court Order
Written Agreement
Oral Understanding
SOURCES OF OTHER INCOME
AMOUNT PER MONTH
$
Is any income listed in this Section likely to be reduced before the credit request is paid off?
No
Yes (Explain)
Has Joint Applicant or Other Party ever received credit from us?
No
Yes - When?
SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION
Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.
NAME (Last, First, Middle)
BIRTHDATE
TELEPHONE NUMBER
DRIVERS LICENSE NUMBER
SOCIAL SECURITY NUMBER
NUMBER OF DEPENDENTS
AGE OF DEPENDENTS
RELATIONSHIP TO APPLICANT (If any)
PRESENT ADDRESS (Street, City, State, Zip)
HOW LONG
EMPLOYER (Company Name & Address)
HOW LONG
BUSINESS PHONE
EXT
POSITION OR TITLE
SALARY PER MONTH
GROSS: $
NET: $
PREVIOUS EMPLOYER (Company Name & Address)
HOW LONG
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, or separate maintenance received under
Court Order
Written Agreement
Oral Understanding
SOURCES OF OTHER INCOME
AMOUNT PER MONTH
$
INCOME LIKELY TO BE REDUCED
No
Yes (Explain)
JOINT APPLICANT OR OTHER PARTY RECEIVED CREDIT FROM US
No
Yes - When?
SECTION C - MARITAL STATUS
Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested.
APPLICANT
Married
Separated
Unmarried (including single, divorced, and widowed)
OTHER PARTY
Married
Separated
Unmarried (including single, divorced, and widowed)
SECTION D - ASSET AND DEBT INFORMATION
ASSETS OWNED (Use a separate sheet if necessary)
Description of Assets
NAME ACCOUNT IS CARRIED
SUBJECT TO DEBT
VALUE
CHECKING ACCOUNT NUMBERS
SAVINGS ACCOUNT NUMBERS
CERTIFICATE OF DEPOSITS
MARKETABLE SECURITIES
REAL ESTATE
LIFE INSURANCE
AUTOMOBILES
OTHER
TOTAL ASSETS
OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages and other obligations. Use separate sheet if necessary.)
CREDITOR
ACCOUNT NUMBER
NAME ACCOUNT IS CARRIED
ORIGINAL AMOUNT
PRESENT BALANCE
MONTHLY PAYMENTS
LANDLORD OR MORTGAGE HOLDER
Rent Payment
Mortgage
(OMIT RENT)
(OMIT RENT)
AUTOMOBILES
TOTAL DEBITS
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable):
Are you obligated to make Alimony, Support or Maintenance Payment?
No
Yes
If yes, to (Name & Address)
Amt. per month $
Are you a co-maker, endorser, or guarantor on any loan or contract?
No
Yes
If yes, to whom owed?
To whom?
Are there any unsatisfied judgements against you?
No
Yes
If yes, to whom owed?
Amount $
Have you been declared bankrupt in the last 10 year?
No
Yes
If yes, where?
Year?
SECTION E - SECURED CREDIT
Complete only if credit is to be secured. Briefly describe the property to be given as security:
PROPERTY DESCRIPTION
NAMES & ADDRESSES OF ALL CO-OWNERS OF THE PROPERTY
IF THE SECURITY IS REAL ESTATE, GIVE THE FULL NAME OF YOUR SPOUSE (if any).
APPLICANTS SIGNATURE
DATE
OTHER SIGNATURE
DATE
Pioneer Bank
PO Box 130, Roswell, NM 88202
Phone: (575)624-5200 | Fax: (575)624-5288
info@pioneerbnk.com
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