Chickasaw Community Bank

Personal Loan Application

IMPORTANT: Please read these directions before completing this application. Check the appropriate box.

Individual Credit
Joint Credit

We intend to apply for joint credit. Please print your names below if you intend to apply for joint credit

Section A – Applicant

You are applying for individual credit or an individual account, in your own name, and are relying on your own income or assets and not the income or assets of another person as the If basis for repayment of the credit requested, complete only Sections A & B. If the requested credit or account is to be secured, also complete the first part of Section C.

Section B – Income and Employment

You are applying for individual credit or an individual account, in your own name, and are relying on your own income or assets and not the income or assets of another person as the If basis for repayment of the credit requested, complete only Sections A & B. If the requested credit or account is to be secured, also complete the first part of Section C.

Section C – Joint Applicant, User or Other Party

If this Section of Application is completed, the indebtedness of Co-Applicant/Guarantor/Endorser must be shown under the "Liabilities and Indebtedness" Section above. (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)

Signatures

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not loan is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.

Important Information About Procedures for Opening a New Account

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

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