"Consumer Credit Application Form - Vista Bank"

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Consumer Credit Application
Important Applicant Information: Federal law requires financial institutions to obtain sufficient information to verify your identity.
/
/
You may be asked several questions and to provide one or more forms of identification to verify your identity. In some instances we
Date
may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.
Amount Requested
Payment Date Desired
Type of Credit Requested
(Check the appropriate boxes.)
For How Long
Secured
Want To Repay Monthly
Individual - relying solely on my income or assets
Unsecured
Proceeds to be used for
Individual - 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
Initials
Applicant Information
Name
SS/Tax ID
DL No.
DL Exp. Date
(Last, First, Middle)
Birthdate
Phone No.
Alt. Phone No.
No. Dependents
Ages Of Dependents
Own
Rent
(Own/Rent How Long)
Address
County
(Street, City, State & Zip)
Own
Rent
(Own/Rent How Long)
Previous Address
County
(Street, City, State & Zip) (Complete If Less Than 3 Years At Present Address)
Have you ever had any of the following with us?
A Checking/Savings Account
A Loan
A Certificate of Deposit
No
Yes, When
No
Yes, When
No
Yes, When
Employer
How Long
(Company Name & Address)
Salary
Commission
Business Phone
Ext.
Position/Title
Income:
Gross
Net
$
Per
Previous Employer
(Company Name & Address) (Complete If Less Than 3 Years At Present Employer)
Name & Address Of Nearest Relative
(Not Living With You)
Relationship
Phone 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:
Court Order
Written Agreement
Oral Understanding
Other Income $
Per
Source Of Other Income
Is income listed in this section likely to be reduced before the credit is paid off? No
Yes
Explain
Joint Applicant
Complete for joint credit, or relying on income or assets from other sources, or if applicant resides in community property state
Name
SS/Tax ID
DL No.
DL Exp. Date
(Last, First, Middle)
Birthdate
Phone No.
Alt. Phone No.
No. Dependents
Ages Of Dependents
Address
County
How Long
(Street, City, State & Zip)
Relationship To Applicant
(If any)
Have you ever had any of the following with us?
A Loan
A Checking/Savings Account
A Certificate of Deposit
No
Yes, When
No
No
Yes, When
Yes, When
Employer
How Long
(Company Name & Address)
Salary
Commission
Business Phone
Ext.
Position
$
Per
Income:
Gross
Net
Previous Employer
(Company Name & Address) (Complete If Less Than 3 Years At Present Employer)
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:
Court Order
Written Agreement
Oral Understanding
Other Income $
Per
Source Of Other Income
Is income listed in this section likely to be reduced before the credit is paid off? No
Yes
Explain
Marital Status
Complete for joint or secured credit; or applicant resides or collateral is located in a community property state
Applicant
Married
Separated
Unmarried (Including Single, Divorced, And Widowed)
Joint Applicant
Married
Separated
Unmarried (Including Single, Divorced, And Widowed)
Consumer Credit Application
Important Applicant Information: Federal law requires financial institutions to obtain sufficient information to verify your identity.
/
/
You may be asked several questions and to provide one or more forms of identification to verify your identity. In some instances we
Date
may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.
Amount Requested
Payment Date Desired
Type of Credit Requested
(Check the appropriate boxes.)
For How Long
Secured
Want To Repay Monthly
Individual - relying solely on my income or assets
Unsecured
Proceeds to be used for
Individual - 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
Initials
Applicant Information
Name
SS/Tax ID
DL No.
DL Exp. Date
(Last, First, Middle)
Birthdate
Phone No.
Alt. Phone No.
No. Dependents
Ages Of Dependents
Own
Rent
(Own/Rent How Long)
Address
County
(Street, City, State & Zip)
Own
Rent
(Own/Rent How Long)
Previous Address
County
(Street, City, State & Zip) (Complete If Less Than 3 Years At Present Address)
Have you ever had any of the following with us?
A Checking/Savings Account
A Loan
A Certificate of Deposit
No
Yes, When
No
Yes, When
No
Yes, When
Employer
How Long
(Company Name & Address)
Salary
Commission
Business Phone
Ext.
Position/Title
Income:
Gross
Net
$
Per
Previous Employer
(Company Name & Address) (Complete If Less Than 3 Years At Present Employer)
Name & Address Of Nearest Relative
(Not Living With You)
Relationship
Phone 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:
Court Order
Written Agreement
Oral Understanding
Other Income $
Per
Source Of Other Income
Is income listed in this section likely to be reduced before the credit is paid off? No
Yes
Explain
Joint Applicant
Complete for joint credit, or relying on income or assets from other sources, or if applicant resides in community property state
Name
SS/Tax ID
DL No.
DL Exp. Date
(Last, First, Middle)
Birthdate
Phone No.
Alt. Phone No.
No. Dependents
Ages Of Dependents
Address
County
How Long
(Street, City, State & Zip)
Relationship To Applicant
(If any)
Have you ever had any of the following with us?
A Loan
A Checking/Savings Account
A Certificate of Deposit
No
Yes, When
No
No
Yes, When
Yes, When
Employer
How Long
(Company Name & Address)
Salary
Commission
Business Phone
Ext.
Position
$
Per
Income:
Gross
Net
Previous Employer
(Company Name & Address) (Complete If Less Than 3 Years At Present Employer)
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:
Court Order
Written Agreement
Oral Understanding
Other Income $
Per
Source Of Other Income
Is income listed in this section likely to be reduced before the credit is paid off? No
Yes
Explain
Marital Status
Complete for joint or secured credit; or applicant resides or collateral is located in a community property state
Applicant
Married
Separated
Unmarried (Including Single, Divorced, And Widowed)
Joint Applicant
Married
Separated
Unmarried (Including Single, Divorced, And Widowed)
Consumer Credit Application Cont’d
Assets Owned
Include information about both applicants if applicable. Use a separate sheet if necessary.
Name in Which
Type
Description
Subject to Debt?
Value
Account is Carried
Cash and Deposits
Automobiles
Real Estate
Investments
Other
$ 0.00
Total Assets
Outstanding Debts
Including charge accounts, installment loans, credit cards, rent and mortgages. Use a separate sheet if necessary.
Type
Description
Monthly Payment
Present Balance
Landlord/Mortgage Holder:
Rent
Mortgage
Automobiles
Credit Cards
Other Debt
Total Debts
$
$
0.00
0.00
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?
No
Yes
Amount per month
If yes, to whom?
(Name & Address)
Are you a co-maker, endorser, or guarantor on any loan or contract?
No
Yes If yes, for whom
To whom
Are there any unsatisfied judgments against you?
No
Yes If yes, to whom owed
Amount $
Have you been declared bankrupt in the last 10 years?
No
Yes If yes, where
Year
Collateral Offered
Complete only if credit is to be secured (Briefly describe the property to be given as security)
Property description
Name and addresses of all co-owners of the property
If the security is real estate, give the full name of your spouse (if any)
I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By signing below I authorize the Lender to check my
credit and employment history and to answer questions others may ask the Lender about my credit record with the Lender. I understand that I must update credit information at the Lender’s request if my
financial condition changes.
Date
Date
Other Signature (Where Applicable)
Applicant's Signature
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