NOTE: This application is for consumer Credit Loans ONLY. For Real Estate loans, please contact The Commercial Bank at (606) 474-7811.

For Consumer Credit Loans, complete the application below and print the application. You may present the completed application to a loan officer at any of our offices, mail the application or fax the application. 
IMPORTANT APPLICANT 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.
CONSUMER CREDIT APPLICATION
Secured Unsecured
 
Type of Credit Requested: 
  
Individual Credit - relying on my income or assets 
Individual Credit - relying on my income or assets as well as income or assets from other sources 
Joint Credit      We intend to apply for joint credit (initials) __________
 

Date of application:

 Amount Requested:
 How Long:
 Payment Date Desired:

Want to Repay:

 Amount Per Period:
 Purpose:
 Account Number:
Section A - Individual Applicant Information
Last Name:
 First Name:
 Middle Initial:
  
Birth Date:
 Telephone Number:
 Social Security Number:
Present Address:
 City:
 State:
 Zip Code:
County:
 How Long?:
  
Previous Address:
 City:
 State:
 Zip Code:
County:
 How Long?:
  
Have You Applied For Credit With Us Before?
Yes    No		 When?:
Number of Dependents:
 Dependents Ages:
Name Of Nearest Relative Not Living With You:
 Relationship:
Address:
 Telephone Number:
Employer (Company Name & Address):
 How Long?:
Business Telephone:
 Position / Title:
 How Often Paid?:
 Take Home Salary Per Month:
Previous Employer (Company Name & Address):
 How Long?:
  
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.
Alimony, child support, separate maintenance received under:
 
Court Order
Written Agreement
Oral Understanding
Sources of other income:
 Amount Per Month:
Section B - Joint Applicant or Other Party Information
Last Name:
 First Name:
 Middle Initial:
  
Birth Date:
 Telephone Number:
 Social Security Number:
Present Address:
 City:
 State:
 Zip Code:
County:
 How Long?:
  
Previous Address:
 City:
 State:
 Zip Code:
County:
 How Long?:
  
Have You Applied For Credit With Us Before?
Yes    No		 When?:
Number of Dependents:
 Dependents Ages:
Name Of Nearest Relative Not Living With You:
 Relationship:
Address:
 Telephone Number:
Employer (Company Name & Address):
 How Long?:
Business Telephone:
 Position / Title:
 How Often Paid?:
 Take Home Salary Per Month:
Previous Employer (Company Name & Address):
 How Long?:
  
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.
Alimony, child support, separate maintenance received under:
 
Court Order
Written Agreement
Oral Understanding
Sources of other income:
 Amount Per Month:
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. (*includes single, divorced and widowed) 
 
Applicant: Married Separated Unmarried*
Other Party: Married Separated Unmarried*
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
Description of Assets Name in which the account is carried Value ($) Where
Checking Account Number:
  
  
  
Checking Account Number:
  
  
  
Savings Account Number:
  
  
  
Savings Account Number:
  
  
  
Other Assets:
  
  
  
Total Assets:  
  
Outstanding Debts
Include charge accounts, installment contracts, credit cards, rent, mortgages and other obligations.
Creditor Account Number Name Account is Under Original Amount Present Balance Monthly Payments
(omit rent) (omit rent)

Landlord or Mortgage Holder

Rent Payment  Mortgage
 
Automobiles
(make, model, year)
Total Debts
Complete the following information about both the Applicant and Joint Applicant or Other Person
(if applicable)
Are you obliged to make Alimony, Support or Maintenance Payments?
 
Yes  No		 If yes, to:
(Name & Address)

 		Amount Per Month:
 

Are you a co maker, endorser, or guarantor on any loan or contract?
 
Yes  No 		If yes, for whom owed?

To whom?

Are there any unsatisfied judgments against you?
 
Yes  No 		If yes, to whom owed?

Amount:

Have you been declared bankrupt in the last 10 years?
 
Yes  No		 If yes, where?

Year?

Section E - Secured Credit
Complete only if credit is to be secured. Briefly describe the property to be given as security and indicate if others have an ownership interest.
Property Description:
Name & Addresses of all co-owners of the property:
If the security is real estate, give the full name of your spouse (if any):
Signatures

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. 

Applicant Signature:________________________________________

Other Signature:___________________________________________
(where applicable)