Credit Application

Customer Privacy Notice

In connection with your dealings with us, information has been obtained about you as described in this notice, which we handle as stated in this notice.

1. We collect nonpublic personal information about you from the following sources:

· Information we receive from you on applications or other forms;
· Information about your transactions with us, our affiliates or others; and
· Information we receive from a consumer reporting agency.

2. We may disclose all of the information we collect, as described above, to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements. We may make such disclosures about you as a consumer, customer or former customer.

3. We may also disclose nonpublic personal information about you as a consumer, customer or former customer to non-affiliated third parties as permitted by law.

4. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. In addition, we maintain physical, electronic and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Fields in Bold are required.
Applicant Information
Full Name:
Address 1:
Address 2:
City:
State, Zip: ,   
Years at this location:
E-mail:
Phone:
Date of Birth:
Social Security #:
Employment Information
Employer:
Employer Phone:
Employer City:
Employer State:
Position:
Annual Gross Income:
Years with company:
Financial Information
Bank Name:
Landlord or Mortgage Holder:
Rent or Own:
Authorization
I have answered the questions in this application fully and truthfully.   All the information I have provided is correct.   I authorize you or any affiliated companies to investigate my credit record and check statements I have made.   This application is your property.   I understand that you will keep it whether or not you make the loan I have asked for. 

 


   

Fields in Bold are required.