For purposes of this application please indicate below what this credit application is to be used for.

Description of Product desired for Purchase Approximate amount of money requested Down Payment (if applicable)

APPLICANT INFORMATION

1.) If you live in a community property state, are you:

Married Separated Unmarried

2.) Married applicants can apply for individual credit. Indicate if you would like:

Individual Credit Joint Credit with your Spouse Joint Credit with a Guarantor or Another Applicant

3.) Method of Payment: Payroll Deduction Automatic Share Transfer Cash Payment

4.) Frequency of Payment: Weekly Bi Weekly Semi Monthly Monthly

End Credit Applied For:

VISA Limit Desired $ No. of Cards:

Share Secured VISA: Limit Desired $ No of Cards

Signature Line of Credit: Limit Desired $

Share Secured: Limit Desired $

Other

APPLICANT INFORMATION

First Name Initial Last Name

Social Security Number

Current Street Address Apt No. Since (MO/YR)

City  State Zip Code

County Township

Former Address (Complete if previous address is less than 3 years:

Former Street Address

City St Zip Years There:

Name, Address ,  and Phone Number of Nearest Relative Not Living With You:

EMPLOYMENT AND INCOME (If self employed or retired, financial statements or income tax returns will be required.)

Current Employer Employment Date

Address City St Zip

Work Telephone Position

Monthly Gross Income

Former Employer Position Yrs. There

OTHER INCOME (You need not list income from alimony, child support or separate maintenance payments unless You want it considered in evaluating this application.)

Type of Other Income Monthly Amount $

ASSETS AND DEPOSITS

CHECKING Account No. Interest Rate Approx. Balance

Bank (Other Name) and Address

SAVINGS Account No. Interest Rate Approx. Balance

Bank (Other Name) and Address

OTHER Account No. Interest Rate Approx. Balance

Bank (Other Name) and Address

Car 1 Year / Make / Model Purchase Price Approx. Value

Car 2 Year / Make / Model Purchase Price Approx. Value

Home Owner

( Name on Deed) Purchase Price Approx. Value

CREDIT INFORMATION (Please list allaccounts with balances)

Mortgage Rent

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Credit Card

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Credit Card

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Other Loans

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Other Loans

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Please answer the following. If a yes answer if given, explain

1.) Have you Filed a petition for bankruptcy in the last 10 years? Yes No

If yes, Please explain

2.) Have you ever had any auto, furniture or property repossessed? Yes No

If yes, Please explain

3.) Are you a co-maker or co-signer on any loan? Yes No

For Whom? Amount $

4.) Have you ever had credit in any other name? Yes No

What name?

5.) Have you any suits pending, judgements filed, alimony or support awards against You? Yes No

If yes, Please explain

6.) Have You any obligations not listed? Yes No

7.) Do You have any past due bills? Yes No Explain

8.) Is any income You have listed likely to reduce in the next two years? Yes No

9.) Indicate immigration status: US Citizen Permanent US. Resident Other

If there is no co applicant for consideration of this loan please CLICK HERE to go to optional credit insurance section.

CO-APPLICANT INFORMATION

1.) If you live in a community property state, are you:

Married Separated Unmarried

2.) Married applicants can apply for individual credit. Indicate if you would like:

Individual Credit Joint Credit with your Spouse Joint Credit with a Guarantor or Another Applicant

3.) Method of Payment: Payroll Deduction Automatic Share Transfer Cash Payment

4.) Frequency of Payment: Weekly Bi Weekly Semi Monthly Monthly

End Credit Applied For:

VISA Limit Desired $ No. of Cards:

Share Secured VISA: Limit Desired $ No of Cards

Signature Line of Credit: Limit Desired $

Share Secured: Limit Desired $

Other

APPLICANT INFORMATION

First Name Initial Last Name

Social Security Number

Current Street Address Apt No. Since (MO/YR)

City  State Zip Code

County Township

Former Address (Complete if previous address is less than 3 years:

Former Street Address

City St Zip Years There:

Name, Address ,  and Phone Number of Nearest Relative Not Living With You:

EMPLOYMENT AND INCOME (If self employed or retired, financial statements or income tax returns will be required.)

Current Employer Employment Date

Address City St Zip

Work Telephone Position

Monthly Gross Income

Former Employer Position Yrs. There

OTHER INCOME (You need not list income from alimony, child support or separate maintenance payments unless You want it considered in evaluating this application.)

Type of Other Income Monthly Amount $

ASSETS AND DEPOSITS

CHECKING Account No. Interest Rate Approx. Balance

Bank (Other Name) and Address

SAVINGS Account No. Interest Rate Approx. Balance

Bank (Other Name) and Address

OTHER Account No. Interest Rate Approx. Balance

Bank (Other Name) and Address

Car 1 Year / Make / Model Purchase Price Approx. Value

Car 2 Year / Make / Model Purchase Price Approx. Value

Home Owner

( Name on Deed) Purchase Price Approx. Value

CREDIT INFORMATION (Please list allaccounts with balances)

Mortgage Rent

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Credit Card

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Credit Card

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Other Loans

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Other Loans

Lenders Name Address City/St/Zip

Account No. Interest Rate Original Amount

Balance Monthly Payment

Please answer the following. If a yes answer if given, explain

1.) Have you Filed a petition for bankruptcy in the last 10 years? Yes No

If yes, Please explain

2.) Have you ever had any auto, furniture or property repossessed? Yes No

If yes, Please explain

3.) Are you a co-maker or co-signer on any loan? Yes No

For Whom? Amount $

4.) Have you ever had credit in any other name? Yes No

What name?

5.) Have you any suits pending, judgements filed, alimony or support awards against You? Yes No

If yes, Please explain

6.) Have You any obligations not listed? Yes No

7.) Do You have any past due bills? Yes No Explain

8.) Is any income You have listed likely to reduce in the next two years? Yes No

9.) Indicate immigration status: US Citizen Permanent US. Resident Other

OPTIONAL CREDIT INSURANCE an appropriate application/disclosure will be furnished at the time Your credit is approved.

Complete this Insurance Disclosure if applying for a Credit Line Account. Credit Insurance Disclosures are furnished separately. Your Loan Officer has details. Credit Life and/or Credit Disability Insurance is not required to obtain credit under this plan and will be included only if requested immediately below by the APPLICANT. The insurance rates are shown below. Each month, the insurance charge is calculated by multiplying the outstanding balance of the Account on the last day of the month by the rate shown.

Monthly Premium Rates per $1000 of Outstanding Balance - YOU MUST COMPLETE THIS SECTION.

Credit Life : Single Coverage - $.065 Yes No

Credit Life : Joint Coverage - $1.04 Yes No

Credit Disability : Single Coverage - $1.75 No

If you applied for Credit Insurance. You authorize Us to add the required premiums to Your Account, charge a Finance Charge on the premiums at the rate which applies to Your Account, and forward such premiums to the Insurance Company.

In lieu of this online application, Click the Yes box indicating your acceptance of the terms for Optional Credit Insurance. Yes Please type in Applicant  name here

In lieu of this online application, Click the Yes box indicating your acceptance of the terms for Optional Credit Insurance. Yes Please type in Co-Applicant  name here

SIGNATURES

You warrant the truth of the above information and You realize that it will be relied upon by US in deciding whether or not to grant the credit applied for. You hereby authorize US, our employees and agents to investigate and verify any information provided to US by You. If this application is for any Feature Category contained in Our Credit Line Account Program, You agree and understand that if approved, You are contractually liable according to the applicable terms of the Credit Line Account Agreement and Disclosure. You will receive a copy of that Agreement no later than the time of Your first credit advance and You promise to pay al amounts charges to Your Account according to its terms. If this is a joint application, You agree that such liability is joint and several. you authorize US to accept this online credit application and agree that your signature above will have the same legal force and effect as Your original signature. you assume any risk that may be associated with permitting Us to accept Your online credit application signature.

APPLICANT (please enter your name above in lieu of a signature) DATE

COAPPLICANT (please enter your name above in lieu of a signature) DATE