Single ApplicantJoint ApplicantsCo-signerSecuredUnsecured

Amount Requested: Term:months Purpose:

Collateral: Year: Make: Model:

Purchase Price:  New   Pre-Owned   Refinance

Full Name:
        (First, middle, last, Jr., Sr., II, etc.)

Address:City:State:ZIP:

For: YearsMonthsTime Previous Address:Phone:

Soc. Security:Birthdate:

Driver's License:

U.S. Citizen: Yes  No	Your Immigration Status:

Name of Nearest Relative
Not Living With You:  Phone:

Address:City:State:ZIP:

Employer:  Telephone:

Address:City:State:ZIP:

Position:Length of Employment: YearsMonths

Length of Previous Employment: YearsMonths 

Name of Joint Applicant:
                      (First, middle, last, Jr., Sr., II, etc.)

Address:City:State:ZIP:

Time there: YearsMonths

Phone: Social Security: Birthdate:

Employer:Phone:

Address:City:State:ZIP:

Position: Length Employment: YearsMonths

Monthly Gross Wages:* See Definition Above

U.S. Citizen: YesNo     Their Immigration Status:

Bank Name:Account Types:Checking Savings Other

Total Balances:

Residency:Own  Land Contract  Rent  Manufactured Other

Market Value Of Home:   Mortgage or L/C Balance:

Mortgage/Rent Payment:

Everything I've stated in this application is true to the best of my knowledge. It's an accurate statement of the income I'll rely on to repay. I understand that you will rely on this information in deciding whether or not to grant or continue credit to me and that you may request further information. I also understand that you will not return this application. I authorize you to check my credit and employment history.

Any willful misrepresentation on this statement could result in fine and/or imprisonment under provisions of the U.S. Criminal Code 18 U.S.C.1014.

Print and sign this application, then mail, fax or deliver it to the KCSB office where you maintain your accounts.

Signature of Applicant:        Date:

Signature of Joint Applicant:  Date:

Please be aware that your loan application is subject to our credit terms and loan approval.