Personal Loan Application Flanagan State Bank

Submitter Information(Required)

First Last

This application form is for an individual personal loan. Prefer to apply for a joint personal loan with another applicant? Use this link to find our joint loan application.

Important Information about Procedures for Opening a New Account:
Identification Procedures Requirements: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you:
When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

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Type of Credit Requested

Type of Loan(Required)

Secured

Individual or Joint(Required)

Individual Credit

Joint Credit

Amount Requested(Required)

Term of Loan In Months(Required)

Payment Date Desired

Proceeds of Loan to be Used For(Required)

Referred By

Applicant Personal Information

Name(Required)

First Middle Last

Social Security Number(Required)

Date of Birth(Required)

Driver's License No.(Required)

Driver's License State(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Contact Information

Choose your location where you would like to complete your application(Required)

How Would You Prefer to be Contacted?(Required)

Phone

Mail

When is the best time to arrange an appointment?(Required)

Morning

Lunchtime

Afternoon

Current Address

Home Address Not a P.O. Box(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Years At Home Address(Required)

Home Status(Required)

Own

Rent

Other

Previous Address

Previous Address Not a P.O. Box

Street Address Address Line 2 City State ZIP Code

Years At Previous Address

Dependent and Relative Information:

Number of Dependents

Age of Dependents

Relative Address Not a P.O. Box

Street Address Address Line 2 City State ZIP Code

Relative Phone Number

Applicant Current Employer

Employer's Name(Required)

Employer's Phone(Required)

Employers Address(Required)

Street Address Address Line 2 City State ZIP Code

Your Position

Years at Company

Applicant Previous Employer

Previous Employer's Name

Previous Employer Phone

Previous Employers Address

Street Address Address Line 2 City State ZIP Code

Years at Previous Company

Income

*Alimony, child support, or separate maintenance income need not be included if you do not wish to have it considered as a basis for repaying this obligation.

Salary per Month* (Gross)(Required)

Salary per Month* (Net)(Required)

Other Income Sources

*Alimony, child support, or separate maintenance income need not be included if you do not wish to have it considered as a basis for repaying this obligation.

Alimony, child support, separate maintenance income received under:*(Required)

None

Court Order

Written

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?

Yes

Have you previously received credit from us?

Yes

Applicant 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.

Marital Status

Married

Separated

Unmarried

Not Applicable

Co-Applicant Marital Status

Married

Separated

Unmarried

Not Applicable

Asset & Debt Information - Checking Account

Checking Bank Name

Checking Bank Address

Street Address Address Line 2 City State ZIP Code

Name in Which the Account is Carried

Is this Account Subject to Debt?

Yes

Asset & Debt Information - Savings Account

Savings Account Number

Savings Balance

Savings Bank Name

Savings Bank Address

Street Address Address Line 2 City State ZIP Code

Name in Which the Account is Carried

Asset & Debt Information - Certificate of Deposit

Certificate of Deposit Value

Certificate of Deposit Bank Name

Certificate of Deposit Bank Address

Street Address Address Line 2 City State ZIP Code

Name in Which the Account is Carried

Asset & Debt Information - Marketable Securities Assets

Marketable Securities Value

Issuer

Type

Number of Shares

Name in Which the Asset is Carried

Asset & Debt Information - Real Estate Assets

Real Estate Address

Street Address Address Line 2 City State ZIP Code

Date Acquired

Name in Which the Asset is Carried

Asset & Debt Information - Life Insurance Assets

Life Insurance Face Value

Issuer

Name in Which the Asset is Carried

Asset & Debt Information - Automobile Assets

Automobile Value

Make

Model

Year

Name in Which the Asset is Carried

Asset & Debt Information - Other Assets

Value

Description

Name in Which the Asset is Carried

Asset & Debt Information - Rent or Mortgage Payment

Rent or Mortgage Payment

Rent

Mortgage

Landlord or Mortgage Holder

Name in Which the Lease or Mortgage is Carried

Monthly Payment

Original Amount (Mortgage)

Present Balance (Mortgage)

Asset & Debt Information - Automobile Debt

Automobile Creditor If applicable

Loan Account Number

Make

Model

Year

Name in Which the Loan is Carried

Original Amount

Present Balance

Monthly Payment

Asset & Debt Information - Other Debt

Creditor

Account Number

Name in Which the Debt is Carried

Original Amount

Present Balance

Monthly Payment

Secured Credit

Property Description

Co-Owner Name

Co-Owner Address

Street Address Address Line 2 City State ZIP Code

If the security is real estate, give the full name of your spouse if any

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