Loan Information

Will there be a co-applicant on this loan application? Yes No
(if yes, be sure to fill out the joint information at the bottom)

Amount requested:
Limit requested:

Purpose:
Security:
Length of loan:

Personal Information

First Name:
Middle Initial:
Last Name:
Social Security Number:
Marital Status Married Unmarried (includes single, widowed and divorced)
Age:
Birthdate (mm/dd/yy):

Home Address:
City:
State:
ZIP:
How Long?
Home Phone Number:
Cellular Phone Number:

If you've lived at your current address less than 2 years, please provide your previous home address:

Previous Home Address:
City:
State:
ZIP:
Email Address:


Employment Information:

Work Phone Number:

Employer Name:

Address:
City:
State:
ZIP:
Position:

If less than 6 months at current employer, please provide your previous employer information:

Employer Name:

Address:
City:
State:
ZIP:
Position:


Income & Asset Information

Gross monthly pay:

Other income:
Note: 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.

Savings/Checking balance:
Real Estate - locations, value
Auto - year, make, model
Other Asset
Other Asset


Debt Information
List all debts and credit accounts, replacing "Other" with description. If those listed do not apply, please enter "None" for balance & payment.

Balance
Monthly Payment

Rent or Mortgage:
Credit Card:
Auto Payments:


If this is a request for individual credit, please skip next section and continue with the "Payment Option" section to complete this form.

If this is a joint account, please fill out the following section as well.

First Name:
Last Name:
Social Security Number:
Marital Status Married Unmarried (includes single, widowed and divorced)
Birthdate (mm/dd/yy):

Home Address:
City:
State:
ZIP:
How Long?
Home Phone Number:
Cellular Phone Number:

If you've lived at your current address less than 2 years, please provide your previous home address:

Previous Home Address:
City:
State:
ZIP:


Employment Information:

Work Phone Number:

Employer Name:

Address:
City:
State:
ZIP:
Position:


Income & Asset Information

Gross monthly pay:

Other income:
Note: 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.

Savings/Checking balance:
Real Estate - locations, value
Auto - year, make, model
Other Asset
Other Asset


Debt Information
List all debts and credit accounts, replacing "Other" with description. If those listed do not apply, please enter "None" for balance & payment.

Balance
Monthly Payment

Rent or Mortgage:
Credit Card:
Auto Payments:


Payment Option


Automatic Loan Payment Method

We offer a rate 1/4% lower with auto pay option. You do not have to select an automatic payment method to obtain credit. These are offered to you as a service from our institution. We will contact you with full details on this method of payment if you select it as an option.

Automatic Loan Payment (Payment is transferred monthly on the due date.)
From Savings
From Checking

Any comments or questions you may have for us?



By submitting this application, I/We certify that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize First National Bank of St John to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for, or for any other services offered. This application does not constitute a contract for the extension of credit.

Upon receipt of this application, someone at First National Bank of St John will review your information and get back to you to inform you of the bank's credit decision or to request further information. We appreciate this opportunity to be your financial partner.

Please Print, Sign and Mail or Fax this form to:

Maupins Truck Sales
P.O. Box 490
Dodge City, Kansas 67801