Credit Application

General Application for credit. By submitting this form you are certifying that these statements are correct to the best of your knowledge and are made for the purpose of obtaining financing. You are authorizing us to obtain any information including but not limited to credit reports which we may require concerning this application. You agree that this application shall remain our property whether the financing is granted or not.

Fed. Tax I.D. or S.S. #
Date of Birth
First Name
Middle Initial
Last Name
Business Name
Street Address
City
State
Zip Code
Home Phone
Business Phone
Years at Current Address
Type of Residence
Mailing Address (if different than street address)
Street Address of Previous Address if at current address less than 3 years
Employer Name
Employer Address
City
State
Zip Code
Work Phone
Position
Years on Job
Gross Monthly Salary
Previous Employer (if at current employer less than 2 years)
Employer Address
City
State
Zip Code
Work Phone
Position
Years on Job
Gross Monthly Salary
If you are self-employed, what is your type of business?
Business Activity
Number of years Farming
Total number of acres
Type of Livestock or Crops
Estimated Annual Farm Income
Market Date
Other Source of Income
Gross Monthly Amount
Nearest Relative Not Living With You
Address
City/State/Zip
Phone number
Relationship
Bank Name
Address
City/State/Zip
Phone number
Person to Contact
Account Number
Landlord/Mortgager Name
Address
City/State/Zip
Phone number
Person to Contact
Account number
Indicate Which of these Items May Apply to You