Credit Application

APPLICATION INFORMATION
Credit Application This is a secure form that will be submitted to First Bank of Owasso.
*Application for
*Application type
*Amount Requested
*Select One	I am applying for individual credit in my own name, and am relying on my own income or assets and not the income or assets of another person as the basis for repayment of the credit requested. I am applying for individual credit, but I am relying on income from alimony, child support, or SEPARATE maintenance or on the income or assets of another person as the basis for repayment of the credit requested. We intend to apply for Joint Credit.
If you are applying for secured credit, please select marital status below:	Married Unmarried (including single, divorced, widowed) Separated
*Purpose of Loan

Borrower
*Name (First M. Last)
*D.O.B.
*School Years Attended
*Present Address
*City, State Zip	,
*Number of Years at this address
*Rent or Own	Rent Own
*Former Address (If less than 2 years at current address)
*City, State Zip	,
*Number of Years at this address
*Rent or Own	Rent Own
*Driver's License Number
*Phone Number
*Social Security Number
Business Phone
Number of dependents other than listed by Co-Borrower
Dependents' ages
Name of Employer
Years employed in this line of work or profession
Employer Address
Employer City, State Zip	,
Years on this job
	Self-employed
Position/Title
Type of Business

Co-Borrower
Name (First M. Last)
D.O.B.
School Years Attended
Present Address
City, State Zip	,
Number of Years at this address
Rent or Own	Rent Own
Former Address (If less than 2 years at current address)
City, State Zip	,
Number of Years at this address
Rent or Own	Rent Own
Driver's License Number
Phone Number
Social Security Number
Business Phone
Number of dependents other than listed by Co-Borrower
Dependents' ages
Name of Employer
Years employed in this line of work or profession
Employer Address
Employer City, State Zip	,
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+	$	$	$	Homeowner Assn Dues	$
+(Before completing Other Income, see notice under "Describe Other Income" below)
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
Borrower/Co-Borrower
Previous Emplr./School
City
State
Type of Business
Position/Title
Dates	from: to:
Monthly Income

Borrower/Co-Borrower
Previous Emplr./School
City
State
Type of Business
Position/Title
Dates	from: to:
Monthly Income

Borrower/Co-Borrower
Previous Emplr./School
City
State
Type of Business
Position/Title
Dates	from: to:
Monthly Income

THESE QUESTIONS APPLY TO BOTH BORROWERS
	Borrower	Co-Borrower
*Have you any outstanding judgments?	Yes No	Yes No
*In the last 14 years, have you been bankrupt?	Yes No	Yes No
*Have you had property foreclosed upon or given title or deed in lieu of?	Yes No	Yes No
*Are you a co-maker or endorser on a note?	Yes No	Yes No
*Are you a party in a law suit?	Yes No	Yes No
*Are you obligated to pay alimony, child support, or separate maintenance?	Yes No	Yes No
*Do you have health and accidental insurance?	Yes No	Yes No
*Do you have major medical coverage?	Yes No	Yes No
If a yes answer was given to a question in this column, explain here.

Assets
Description	Cash or Market Value
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. Number	$
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. Number	$
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. Number	$
Stocks & Bonds (Company name/number & description)
Acct. Number	$
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
Description	Monthly Payment	Unpaid Balance
Name and address of Company Acct. Number	$	$
Name and address of Company Acct. Number	$	$
Name and address of Company Acct. Number	$	$
Name and address of Company Acct. Number	$	$
Name and address of Company Acct. Number	$	$
Name and address of Company Acct. Number	$	$
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
Type of Property	Present Market Value	Amt. of Mortgages & Liens	Gross Rental Income	Mortgage Paymts.	Taxes, Ins., Maint. and Misc.	Net Rental Income
	$	$	$	$	$	$
Address of Property:
	$	$	$	$	$	$
Address of Property:
	$	$	$	$	$	$
Address of Property:
Totals	$	$	$	$	$	$

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. First Bank of Owasso is authorized to verify, exchange and retain credit and employment information contained herein and relative to this application.