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.
Mortgage
Information
Will there be a co-applicant on this
application?
Yes or No
Amount requested
Purpose
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 any
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 creditor
unless the creditor, prior to the time the credit is extended, or an
open-end credit plan is entered into, is furnished with a copy
of the agreement statement or decree, or has actual knowledge of the adverse provision
when the obligation to the creditor is incurred.
Personal Information
First Name: *
Middle Initial:*
Last Name:*
Email Address:*
Social Security Number:*
Marital Status:*
Married
Unmarried
(includes single, widowed and divorced)
Birthdate:*
(xx/xx/xxxx)
Address:*
City:*
State:*
Zip:*
How Long?*
Home Phone Number, with
area code:*
If you've lived at your current address less
than 2 years, please provide your previous home address:
Previous Address:
City:
State:
Zip:
How Long?
Employment Information
Work Phone Number:*
Employer:*
Address:*
City:*
State:*
Zip:*
Position:*
How Long Employed:
Salary per Month:
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.
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:
How Long Employed:
Salary per Month:
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
Property Information
Property Address:
City:
State:
Zip:
Annual Property Taxes:
Annual condo/PUD fees:
Annual Hazard Insurance:
Information Requested by the Federal Government
Please complete this section only if you are applying for a term loan and any portion of the funds will be used to purchase or improve a home, or to refinance an existing loan that was used to purchase or improve a home.
The following information is requested by the federal government for certain types of loans related to a dwelling. This information is used to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but we encourage you to do so. The law provides that a lender may not discriminate on the basis of this information, nor on the way you wish to furnish it. If you choose not to complete this section, under federal regulations, we are required to note race or national origin and sex on the basis of visual observation or surname.
Applicant (A): I do not wish to furnish this information
Race or National Origin:
If you selected "Other" above, please specify:
Ethnicity:
Sex:
Co-Applicant (C): I do not wish to furnish this information
Race or National Origin:
If you selected "Other" above, please specify:
Ethnicity:
Sex:
Any comments or questions you may have for us?
This application may now 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.
