Please fill out all fields and print two copies. One is for
your records, the other can be faxed to #608-582-4511 or mailed to
Bank of Galesville, Attn: Lending, PO Box 429, Galesville, WI
54630. Or you can always stop by any of our locations and drop
it off. Any questions or comments, please feel free to contact
the bank.
The offer of credit is subject to approval.
Loan Information
Will there be a co-applicant on this loan
application?
Yes or No
Amount requested
Purpose
Security
If Other, please specify Security
Length of Loan
Credit Type
You may apply for individual or joint credit, but
choose only one of the following. Thank
you.
Individual Credit
- unmarried applicant
Individual Credit -
married applicant
Joint Credit - with
your spouse
Joint Credit - with
an applicant or cosigner who is not your spouse
Notice to married applicant: No provision of a
marital property agreement, a unilateral statement under Wis. Stat. sec 766.59 or a court
decree under Wis Stat. sec 766.70 adversely affects the interests of the bank
unless prior to the time the credit is extended, the bank is furnished with a copy
of the agreement statement or decree, or has actual knowledge of the adverse provision
when the obligation to the bank is incurred.
Personal Information
First Name:
Middle Initial:
Last Name:
Social Security Number:
Marital Status:
Married
(for secured credit or Wisconsin
Unmarried
Residents Only)
(includes single, widowed and divorced)
Birth Date:
Drivers License Number:
(xx/xx/xxxx)
State of Issuance:
Home Address:
City:
State:
Zip:
How Long?
Home Phone Number:
If you've lived at your current address less
than 2 years, please provide your previous home address:
Previous Home Address:
City:
State:
Zip:
Employment Information
Work Phone Number:
Employer name:
Address:
City:
State:
Zip:
Position:
Salary per Month:
How Long Employed:
Source of other income
Note: 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.
Amount per month:
Joint or Other Applicant Information
If your loan application is for joint credit, for
individual credit relying on income or assets from other sources, or you
are married and reside in a community property state,
you must also fill out this section of the application. If
you are applying for individual credit, you can skip this section.
Name:
Social Security Number:
Marital Status:
Married
Unmarried
(includes single, widowed and divorced)
Birth Date:
Drivers License:
(xx/xx/xxxx)
State:
Home Address:
City:
State:
Zip:
How Long?
Home Phone Number:
If you've lived at your current address less
than 3 years, please provide your previous home address:
Previous Home Address:
City:
State:
Zip:
Employment Information
Work Phone Number:
Employer name:
Address:
City:
State:
Zip:
Position:
Salary per Month:
How Long Employed:
Source of other income
Note: 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.
Amount per month:
Asset Information
Savings/Checking balance
Real Estate- locations, value
Auto - year, make model
Other Asset
Other Asset
Debt Information
List all debts and
credit accounts, replacing "Other" with description. If those listed do not
apply, please say "None" for balance & payment..
Balance
Monthly Payment
Rent or Mortgage
Credit Card
Auto Payments
Any comments or questions you may have for us?
Email Address:
This application can be printed and faxed to
#608-582-4511 or mailed to Bank of Galesville, Attn: Lending, PO Box
429, Galesville, WI 54630. Or you can always stop by any of our
locations and drop it off.
By submitting this application, I/We certify that this
information has been supplied truthfully, accurately and voluntarily, and therefore
authorize Bank of Galesville to investigate our creditworthiness, credit history
and financial responsibility through any credit bureau or by any other reasonable means
for consideration for the loan applied for, or for any other services offered.
This
application does not constitute a contract for the extension of credit.
Thank You. Upon receipt of this application, someone
at Bank of Galesville will review your information and get back to you to extend
credit, with additional questions or to request further information. We appreciate
this opportunity to be your financial partner.
