Please complete and print the loan application below and fax to (870) 763-3500.
Loan Application
Will there be a joint applicant on this Loan Application?
Yes No
Type of loan requested
Amount requested
$
Primary Applicant
Account Number
with us, if you have one.
E-Mail Address
(name@domain.com)
Last Name
First Name
Middle Initial
Home Phone Number
Business Phone Number
Address 1:
Address 2:
City:
State:
Zip:
Social Security No.
(no dashes or spaces)
Date of Birth
Employer's Name
Employer's Phone No.
How long have you been employed?
Annual Gross Income $
Please provide the following information only if you've been employed less than two years with your current employer.
Previous Employer
(If at Present employer less than 2 years)
Employer's Phone No.
How long
Annual Gross Income $
Joint Applicant (if applicable)
Account Number
Last Name
First Name
Middle Initial
Home Phone Number
Business Phone Number
Social Security No.
Date of Birth
Employer's Name
Employer's Phone No.
Annual Gross Income $
How long
Please provide the following information only if Joint Applicant has been employed less than two years with their current employer.
Previous Employer
(If at Present employer less than 2 years)
Employer's Phone No.
How long
Annual Gross Income $
Monthly Expenses
In addition to rent or mortgage, list debts that may not appear on a credit report (for example, home owners association dues, alimony, child support, child care, IRS liabilities, 401K loans etc.).

Debts Monthly Payment

Please note: Income verification is required; other information may be required.

I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below, I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.

INSURANCE DISCLOSURE FOR CREDIT APPLICATION
IMPORTANT
DO NOT SIGN THIS STATEMENT UNTIL YOU CAREFULLY READ IT AND UNDERSTAND IT’S CONTENTS

Purpose
You have submitted an application for a loan. In connection with your loan application, Lender may be soliciting, offering to sell, or will sell you and insurance product or annuity. Federal Law requires Lender to provide you with the following disclosures.

Credit Disclosure purpose
  1. Lender, as a condition of granting you a loan, cannot require that you purchase an insurance product or annuity from Lender or any of its affiliates.
     
  2. Lender, as a condition of granting you a loan, cannot require your agreement not to obtain or prohibit you from obtaining an insurance product or annuity from an unaffiliated entity.



Primary Applicant Signature & Date
 
 
Joint Applicant Signature & Date