Credit Application

Important Information:

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, or apply for a loan, we will ask 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.

Please indicate whether you intend to apply for individual or joint credit.  Applicants for joint credit should complete the applicable co-borrower sections of the application. Co-borrower information must be provided when the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification, or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the secured property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

You must be a U. S. Citizen with a U.S. address and Social Security number to apply online.  All other applicants should contact us at 701-782-6295 .

APPLICATION INFORMATION
Application for:   Amount Requested:  
Application Type: IndividualJoint

Purpose of Loan:

BORROWER
Name D.O.B. (MM/DD/YY) School Yrs Attended:
Present Street Address

Notice:  Do not enter a P. O. Box unless you are currently serving in the military.

City:   State:    ZIP Code:

Number of Years at this address:       Own     Rent

Former Street Address   City: State:    ZIP Code: 
(if less than 2 years at present address)
Number of Years at this address::      Own     Rent
Driver's License Number Phone #   (000-000-0000)
DL State Issued Business Phone  (000-000-0000)
Social Security Number Email 
Marital Status
Married
Unmarried
(including single, divorced, widowed)
Separated

Notice: Marital status should only be completed if applicant is applying for joint or secured credit, or if applicant resides in a community property state, or is relying on property located in such a state.

Dependents other than listed by Co-Borrower:  No. Ages
Name of Employer
Street Address
City   State      Zip 
Years employed in this line of work or profession?    yrs.
Years on this job 
Self-employed
Position/Title  Type of Business

CO-BORROWER
Name D.O.B. (MM/DD/YY) School Yrs Attended:
Present Street Address

Notice: Do not enter a P. O. Box unless you are currently serving in the military.

  City: State:    ZIP Code:

Number of Years at this address: Own     Rent
Former Street Address   City: State:    ZIP Code:
(if less than 2 years at present address)
Number of Years at this address: Own     Rent
Driver's License Number   Phone #   (000-000-0000)
DL State Issued Business Phone  (000-000-0000)
Social Security Number Email Address 
Marital Status
Married
Unmarried
(including single, divorced, widowed)
Separated

Notice: Marital status should only be completed if applicant is applying for joint or secured credit, or if applicant resides in a community property state, or is relying on property located in such a state.

Dependents other than listed by Co-Borrower:  No. Ages
Name of Employer
Street Address
City State      Zip 
Years employed in this line of work or profession?    yrs.
Years on this job 
Self-employed
Position/Title  Type of Business

GROSS MONTHLY INCOME MONTHLY HOUSING EXPENSE
Item Borrower Co-Borrower Total Item Total
Base Empl. Income $ $ $ Rent $
Overtime First Mortgage (P&L)
Bonuses Other Financing
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxes
Net Rental Income Mortgage Insur.
Other+
(Before completing, see notice under Describe Other Income below)
Homeowner Assn. Dues
              
              
Total $ $ $    $

DESCRIBE OTHER INCOME

NOTICE
+ Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered as a basis for repaying this loan.

Item Monthly Amount
  
     
     
     
     

IF EMPLOYED IN CURRENT POSITION LESS THAN 2 YEARS COMPLETE THE FOLLOWING
B/C Previous Emplr./School City/State  Type of Bus. Position/Title Dates Monthly Income

THESE QUESTIONS APPLY TO BOTH BORROWERS
  B
Y/N
C
Y/N
  B
Y/N
C
Y/N
If a yes answer is given to a question in this section, explain on an attached sheet.      Are you a co-maker or endorser on a note?
Are you obligated to pay alimony, child support, or separate maintenance?
Have you any outstanding judgments? Do you have health and accidental insurance?
In the last 14 years, have you been bankrupt? Do you have major medical coverage?
Have you had property foreclosed upon or given title or deed in lieu of? Are you a U. S. Citizen?
Are you a party in a law suit? Are you a permanent resident alien?

 Assets & Liabilities

This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-borrowers if assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate statements and schedules are required. If the co-borrower section was completed about a spouse, this statement and supporting schedules must also be completed about that spouse.

Completed: Individual Jointly

Assets (Description) Cash or Market Value
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No.  $
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No.  $
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No.  $
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No. 
Stocks & Bonds (Company name/number & description)
$  
Life Insurance net cash value:      Face amount: $  $  
Subtotal Liquid Assets $  
Real Estate owned (enter market value from schedule of real estate owned) $  
Vested interest in retirement fund $  
Net worth of business(es) owned (attach financial statement) $  
Automobiles owned (make and year) 

Other Assets (itemize)

Total Assets a.

$  

 

Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary.

Liabilities Monthly Payment Unpaid Balance
Name and address of Company
Acct. No.  
Name and address of Company
Acct. No.  
Name and address of Company
Acct. No.  
Name and address of Company
Acct. No.  
Name and address of Company
Acct. No.  
Name and address of Company
Acct. No.   
Alimony/Child Support/Separate Maintenance Payments Owed to:  
Job Related Expense (child care, union dates, etc.)
Total Monthly Payments $  
  Total Liabilities b.  

SCHEDULE OF REAL ESTATE OWNED
(If Additional Properties Owned Attach Separate Schedule)

Address of Property
Type of Property*
Present Market Value Amt. of Mortgages & Liens Gross Rental Income Mortgage Paymts. Taxes, Ins., Maint. and Misc. Net Rental Income
$ $ $ $ $ $
           
           

TOTALS 

$ $ $ $ $ $
* Indicate S if Sold, PS if Pending Sale or R if Rental being held for income

LIST PREVIOUS CREDIT REFERENCES

Borrower  or   CoBorrower Creditor's Name and Address Account Number Purpose Highest Balance Date Paid
List any additional names under which credit has previously been received.

 

Disclosure

I/We certify that the information on this application is true and complete to the best of my/our knowledge. The Bank of Hazelton is authorized to verify, exchange and retain credit and employment information contained herein and relative to this application.