Consumer Credit Application

Step-1


TYPE OF CREDIT REQUESTED - Check appropriate boxes below and complete the applicable section
Type of Credit
    SECURED
    UNSECURED
Individual or Joint
    INDIVIDUAL CREDIT - relying solely on my income or assets
    INDIVIDUAL CREDIT - relying on my income or assets as well as income or assets from other sources including community property
    JOINT CREDIT - We intend to apply for joint credit (initials)
AMOUNT REQUESTED FOR HOW LONG PAYMENT DATE DESIRED DESIRED REPAYMENT PROCEEDS OF LOAN TO BE USED ON

IMPORTANT APPLICATION INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

  • SECTION A - INDIVIDUAL APPLICANT INFORMATION

  • If you have been at your current place of employment less than 2 years, please provide us with your previous employer information below

  • Alimony, child support or maintenance income need to be revealed if you do not wish to have it considered as basis for repaying this obligation
    Alimony, Child Support, separate maintenance received under:

Step-2


  • SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION

    Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.

  • Alimony, child support or maintenance income needs to be revealed if you do not wish to have it considered as basis for repaying this obligation
    Alimony, Child Support, separate maintenance received under:

  • SECTION C - Marital Status

    Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying
    on property located in such a state as a basis for repayment of the credit requested.

Step-3


  • SECTION D - ASSET & DEBT INFORMATION

    If Section B has been completed, this section should be completed giving information about both the Applicant and Joint Applicant or Other Person.
    Please mark Applicant-related information with an "A". If Section B was not completed, only give information about the Applicant in this Section.

  • ASSETS OWNED (Use separate sheet if necessary.)
  • Add Another
  • OUTSTANDING DEBTS (Include charge accounts, installment contracts)

  • Complete the following information about both the Applicant and Joint Applicant or Other Person (if Applicable)

  • SECTION E - SECURED CREDIT complete only if credit is to be secured. Briefly describe the property to be given as security:

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

  • __________________________________
  • __________________________________
  • __________________________________
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Step-4

CONSUMER CREDIT INSURANCE DISCLOSURE

This document is a written disclosure for the sale of insurance or annuities when Green Belt Bank & Trust extends credit.

To Credit Applicant:


Green Belt Bank & Trust advises you that Green Belt Bank & Trust may not condition the extension of credit on the following:

  • Your purchase of an insurance product or annuity from Green Belt Bank & Trust or any of our affiliates;
  • Your agreement not to obtain, or a prohibition on obtaining, an insurance product or annuity from an unaffiliated entity.

Insurance and Annuities

  • Are not a deposit account or other obligation of Green Belt Bank & Trust or any affiliate of Green Belt Bank & Trust;
  • Are not guaranteed or insured by Green Belt Bank & Trust;
  • Are not insured by the Federal Deposit Insurance corporation (FDIC);
  • Are not, except in the case of Federal Flood Insurance or Federal Corp Insurance, insured by any federal government agency;
  • May involve investment risk, including possible loss of value.

By signing, I acknowledge that I have received this disclosure orally and in writing.


  • __________________________________________
  • __________________________________

JOINT APPLICANT OR OTHER PARTY

Complete only if you are filing with a joint applicant. (Note if you add a joint applicant at this point, you may need to return to steps 2 and 3 to complete additional fields).

  • __________________________________________
  • __________________________________
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FOR CREDITOR USE

DATE ______________________

CLASS NO ____________________

ACCOUNT NO. __________________________________________________

APPROVED    DECLINED    BY _____________________

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