PBK

info@anbbank.com | 866-433-0282 | NMLS# 457261

CREDIT APPLICATION

   

    INDIVIDUAL CREDIT      


     JOINT CREDIT              

  
We intend to apply for joint credit (initial)
Applicant (Initials)

Co-Applicant (Initials)

          
AMOUNT REQUESTED
$
PURPOSE

SECTION A - INDIVIDUAL APPLICANT INFORMATION

LAST NAME:

 
FIRST NAME:

 
MIDDLE NAME:

 

SOCIAL SECURITY#:
 

  BIRTHDATE: (mm/dd/yyyy)
 
  
EMAIL:

TELEPHONE NO. (H)
 
 
TELEPHONE NO. (C)
 

#OF DEPENDENTS:
 

 AGES OF DEPENDENTS:

ADDRESS (Street, City, State & Zip)
   

  COUNTY

Do you

    HOW LONG
 

PREVIOUS ADDRESS (Street, City, State & Zip)
(Complete if less than 3 years at present address)

 

  COUNTY   

Do you

    HOW LONG 
 

EMPLOYER (Company Name & Address)
 

    HOW LONG
 

BUSINESS PHONE                          EXT.    
 

POSITION OR TITLE  

GROSS SALARY PER MONTH
 
PREVIOUS EMPLOYER (Company Name & Address)
 

    HOW LONG
 

NAME & ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU                RELATIONSHIP                   TELEPHONE NO. (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, separate maintenance received under: 

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? 
  (Explain) 
Have you ever received credit from us?
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 NO.
 

DRIVER’S LICENSE
 

SOCIAL SECURITY NO.

# OF DEPENDENTS
 
  AGES OF DEPENDENTS
 
RELATIONSHIP TO APPLICANT (if any)
 
ADDRESS (Street, City, State & Zip)
 

   HOW LONG
 

EMPLOYER (Company Name & Address)
 

   HOW LONG
 

BUSINESS PHONE                            EXT.
 
 

POSITION OR TITLE
 

GROSS SALARY PER MONTH
 
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, separate maintenance received under:
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?
  (Explain) 
Have Joint Applicant or Other Party received credit from us? When? 

SECTION C - MARITAL STATUS
Complete only if: for joint or secured credit, or applicant resides in a community property state relying on property located is such a state
as a basis for repaying credit requested.

APPLICANT          
OTHER PARTY    

SECTION D - ASSET & DEBT INFORMATION

If Section B is completed, this section should be completed giving information about both the Applicant and Joint Applicant or Other Person.

ASSETS OWNED (Use separate sheet if necessary)                                         

DESCRIPTION OF ASSETS

NAME OF OWNERS

SUBJECT TO DEBT?

VALUE

CHECKING ACCT NUMBER(s) (where)
 

SAVINGS ACCT NUMBER(s) (where)
 

CERT(s) OF DEPOSIT (where)
 

MARKETABLE SECURITIES
(Issuer, type, no. of shares)
 

REAL ESTATE (location, date acquired)
    

 

CASH VALUE OF LIFE INS.
 (Issuer, face value)
 

AUTOMOBILES (make,model year)
 

OTHER (list)
 
 

TOTAL ASSETS                                                                                                              

OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use separate sheets if necessary.)
CREDITOR

 

ACCOUNT NUMBER NAME IN WHICH THE ACCOUNT IS CARRIED ORIGINAL AMOUNT PRESENT BALANCE MONTHLY PAYMENTS
LANDLORD OR MORTGAGE HOLDER
 
 

$ (Omit Rent)
$

$

AUTOMOBILES (describe)
 

 

CREDIT CARD DEBT  
 

 

TOTAL DEBTS                                                                                    

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 Payments?

If yes, to (Name & Address)  Amount per month $

Are you a co-maker, endorser, or guarantor of any loan or contract?  If yes, from whom?  To whom? 

Are there any unsatisfied judgements against you?    If yes, to whom owed?       Amount $ 

Have you declared bankruptcy in the past 5 years?   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 ADDRESS OR DESCRIPTION: 

Will the property be used as collateral for any additional loan closed simultaneously with this loan?

NAMES & ADDRESSES OF ALL CO-OWNERS OF THE PROPERTY (If the security is real estate, give the full name of your spouse, if any)
IF THE PURPOSE OF THIS LOAN IS FOR HOME IMPROVEMENT OR REFINANCE PLEASE CHECK THIS BOX

SIGNATURES I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.
 

Applicant’s Signature                                                               Date   Other Signature (Where Applicable)                                            Date

 

        

“FOR LENDER USE ONLY.”
To be Completed by Loan Originator:



Loan Originator’s Signature:
X
Date:

Loan Originator’s Name (Print):

Loan Originator Identifier:

Loan Originator’s Phone Number (Including Area code):