First National Bank... Local Roots. Local People. Local Bank

Thank you for your interest in a loan from First National Bank. If you have any questions while completing this form, please call us at (918) 681-1650 or visit us at 510 North Main.
TYPE OF CREDIT REQUEST Individual Credit - Relying solely on my income or assets Individual Credit - Relying on my income or assets as well as income or assets from other sources Joint Credit				Secured Unsecured		Amount requested:
						Proceeds to be used for:
SECTION A - PRIMARY APPLICANT Information
Name (Last, First, Middle):		Social Security Number:			No. of Dependents:
Birthdate:	Home Telephone:		Driver's License No.:				Ages of Dependents:
Current Address: (Street, City, State, Zip)			County:				Do youOwn orRent?
Previous Address: (Street, City, State, Zip) Complete if less than 3 years at present address.			County:				Do youOwn orRent?
Name and Address of Nearest Relative Not Living with You:			Relationship:				Telephone Number:
Alimony, Child Support, or Separate Maintenance Received Under: Court Order Written Agreement Oral Understanding --- Alimony, child support, or separate maintenance income need not be revealed if you not wish to have it considered as a basis for repaying this obligation.
Monthly Salary: Gross $	Sources of other Income:		Amount per Month: $				Is any income listed in this section likely to be reduced before the credit is paid off? No Yes
Section B - Joint Applicant Information
Name (Last, First, Middle):		Social Security Number:			No. of Dependents:
Birthdate:	Home Telephone:		Driver's License No.:				Ages of Dependents:
Current Address: (Street, City, State, Zip)			County:				Do youOwn orRent?
Previous Address: (Street, City, State, Zip) Complete if less than 3 years at present address.			County:				Do youOwn orRent?
Name and Address of Nearest Relative Not Living with You:			Relationship:				Telephone Number:
Alimony, Child Support, or Separate Maintenance Received Under: Court Order Written Agreement Oral Understanding --- Alimony, child support, or separate maintenance income need not be revealed if you not wish to have it considered as a basis for repaying this obligation.
Monthly Salary: Gross $	Sources of other Income:		Amount per Month: $				Is any income listed in this section likely to be reduced before the credit is paid off? No Yes
SECTION C - MARITAL STATUS (Answer only if applying for joint or secured credit.)
MARITAL STATUS: Applicant:Married Separated Unmarried (including single, divorced, and widowed) Other Party:Married Separated Unmarried (including single, divorced, and widowed)
SECTION D - Asset & debt information
Debt Information (Complete the following information about both the Applicant and Joint Applicant or Other Person.) Are you obligated to make Alimony, Support, or Maintenance Payments? No Yes If yes, to whom? (Name, Address) Amount Per Month $ Are you a co-maker, endorser, or guarantor on any loan or contract? No Yes If yes, for whom? To whom: Are there any unsatisfied judgments against you?No Yes If yes, to whom owed? Amount $ Have you been declared bankrupt in the past ten years? No Yes If yes, where? What year?
assets owned
Do you have a Checking Account? No Yes		If yes, Name of Bank/Financial Institution:			Account Number:
Do you have a (check all that apply): Savings Account Money Market Account CD Marketable Securities Life Insurance Automobile Other Assets
Outstanding debts
(Please mark one) List your housing payment and all debts to banks, credit unions, stores, finance companies, and other creditors, including obligations to pay alimony, child support, separate maintenance, etc. for both applicant and co-applicant.
Name of Creditor Own Rent
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
Min. Mo. Payment $ Balance $
SECTION E - SECURED CREDIT (Complete only if credit is to be secured.)
Briefly Describe the Property to be Given as Security:
Names & Addresses of all CVO-Owners of the Property:
If the Security is Real Estate, Give the Name of Your Spouse (if applicable)
SECTION F - SIGNATURES
Insurance Disclosure I have applied for an extension of credit with First National Bank of Muskogee. The bank is soliciting, offering, or selling me an insurance product or annuity in connection with this extension of credit. Federal law prohibits the bank from conditioning the extension of credit on either, 1) purchase of an insurance product or annuity or 2) my agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity. By signing below, I acknowledge that I have received this disclosure orally. Certification I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below, I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes. Applicant Signature Date Joint Applicant Signature (if applicable) Date
View/Print You will still need to print out the application and take to the bank. This option also requires Adobe Acrobat Reader. Submit The application will be sent to the bank over secure channels

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First National Bank of Muskogee
Muskogee, Oklahoma
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