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Loan Wizard

Page 1 of 2

* Required

Preliminary Loan Information

* 1. Select the loan type you are seeking:
Home Equity Line of Credit	Auto
Boat/RV	Unsecured Loan
Visa Card	ATM/Debit Card
* 2. Will you be filing individually or jointly?
Individual Application	Joint Application

Primary Applicant Information

First Name *
Last Name *
Present Street Address *
Address 2
City *
State *
Zip *
Daytime Phone (xxx-xxx-xxxx)
Work Phone & Ext (xxx-xxx-xxxx) *
E-mail Address *
SS Number (xxx-xx-xxxx) *
Date of Birth (mm/dd/yyyy) *
Driver's License No. *
Employment Status *	Employed
	Self-employed
	Retired

Co-Applicant Information

First Name *
Last Name *
Present Street Address *
Address 2
City *
State *
Zip *
Daytime Phone (xxx-xxx-xxxx)
Work Phone & Ext (xxx-xxx-xxxx) *
E-mail Address
SS Number (xxx-xx-xxxx) *
Date of Birth (mm/dd/yyyy) *
Driver's License No. *
Employment Status *	Employed
	Self-employed
	Retired

Primary Applicant Employment Information

Present Employer *
Street Address
Address 2
City *
State *
Zip
Date Started *
Gross Monthly Income *

Co-Applicant Employment Information

Present Employer *
Street Address
Address 2
City *
State *
Zip
Date Started *
Gross Monthly Income	$ .00

Miscellaneous Information

Monthly Mortgage or Rent Payment	$ .00
Monthly Car Payment	$ .00
3. Are you a US Citizen?
Yes	No
4. If no to 3, are you a Permanent Resident Alien?
Yes	No
5. If yes to 4, Registration Number
Other Monthly Income	$ .00

Continue on to page 2.

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