Step 1 of 12 8% Loan Information Important Information About Procedures For Opening A New Account To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may ask to see your driver’s license or other identifying documents.Loan Type*Installment LoanLine of CreditWhich Type of Loan?*Auto LoanHome Equity LoanPersonal LoanWhich Type of Line of Credit?*Eagle Express Line of CreditHome Equity Line of CreditEagle Prime Line of CreditPurpose*Amount* Applicant Information Applicant's Basic InformationIndividual or Joint Account*Individual AccountJoint AccountWe intend to apply for Joint Credit. Applicant Initials*Please enter the Applicant's initials. Co-Applicant Initials*Please enter the Co-Applicant's initials. First Name*Middle InitialLast Name*SuffixDate of Birth* You must be 18 years of age or older to apply.Email Best Contact Telephone Number*(###)###-#### Applicant's Housing InformationCurrent Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Current Address?*Less than 1 year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years31 years32 years33 years34 years35 yearsMore than 35 yearsApplicant's Monthly Housing Payment*Own vs. Rent*OwnRent Previous Address (complete if less than two years at present address) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Previous Address?Less than 1 year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years31 years32 years33 years34 years35 yearsMore than 35 years Applicant's Employment InformationPresent Employer - Company Name*Present Employer - Company Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Present Employer?*Less than 1 year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years31 years32 years33 years34 years35 yearsMore than 35 yearsPosition or TitleWages*Wages*WeeklyBi-WeeklyMonthly Previous Employer - Company Name*Previous Employer - Company Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Previous Employer?Less than 1 year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years31 years32 years33 years34 years35 yearsMore than 35 years Additional Sources of IncomeAmount Per Month Applicant's Additional InformationApplicant's Marital StatusMarriedSeparatedUnmarried (including single, divorced, widowed)Do not complete if this is an application for individual unsecured credit.Secured CreditSecured - Briefly describe the property that is to be given as security. Owner/Co-Owner's Name of CollateralAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Owner/Co-Owner's Name of CollateralAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Spouse's NameIf Security is Real Estate, Provide the Full Name of Your Spouse (if any)Nearest Relative Not Living with YouName of RelativeAddress of Relative Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code RelationshipPhone(###)###-#### Co-Applicant's Basic Information First Name*Middle InitialLast Name*SuffixDate of Birth* You must be 18 years of age or older to apply.Relationship to Applicant*Check box if Co-Applicant lives at same address as Applicant Use same address as Applicant's address Co-Applicant's Current Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Current Address?*Less than 1 year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years31 years32 years33 years34 years35 yearsMore than 35 yearsBest Contact Telephone Number*(###)###-####Co-Applicant's Employment InformationPresent Employer Company Name*Present Employer Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Present Employer?*Less than 1 year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years31 years32 years33 years34 years35 yearsMore than 35 yearsPosition or TitleWages*Wages*WeeklyBi-WeeklyMonthly Assets Vehicle #1 Year2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990OtherVehicle #1 Make(Examples: Toyota, Ford, Honda, etc.) Vehicle #1 Value(Examples: $ 15,500, $ 23,200, etc.) Vehicle #2I do not have a 2nd vehicleI do have a 2nd vehicleVehicle #2 Year2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990OtherVehicle #2 MakeVehicle #2 Value Vehicle #3I do not have a 3rd vehicleI do have a 3rd vehicleVehicle #3 Year2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990OtherVehicle #3 MakeVehicle #3 Value Vehicle #4I do not have a 4th vehicleI do have a 4th vehicleVehicle #4 Year2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990OtherVehicle #4 MakeVehicle #4 Value Assets Account #1 Checking or Savings Account(Example: Checking)Account #1 Balance(Example: $ 515.17) Account #1 Financial Institution(Example: Susquehanna Community Bank) Account #2I do not have a 2nd accountI do have a 2nd accountAccount #2 Checking or Savings AccountAccount #2 BalanceAccount #2 Financial Institution Account #3I do not have a 3rd accountI do have a 3rd accountAccount #3 Checking or Savings AccountAccount #3 BalanceAccount #3 Financial Institution Account #4I do not have a 4th accountI do have a 4th accountAccount #4 Checking or Savings AccountAccount #4 BalanceAccount #4 Financial Institution Real Estate OwnedReal Estate Owned (Address)ValueReal Estate Owned (Address)ValueReal Estate Owned (Address)Value Other AssetsPersonal Property or Other Asset(Examples: Stocks, CD, Jewelry, etc.)Value(Example: $ 15,000)Personal Property or Other AssetValuePersonal Property or Other AssetValuePersonal Property or Other AssetValue Liabilities Installment Debts (include revolving accounts) Financial InstitutionMonthly PaymentUnpaid BalanceFinancial InstitutionMonthly PaymentUnpaid BalanceFinancial InstitutionMonthly PaymentUnpaid BalanceFinancial InstitutionMonthly PaymentUnpaid BalanceFinancial InstitutionMonthly PaymentUnpaid Balance Real Estate Loans Financial InstitutionMonthly PaymentUnpaid BalanceFinancial InstitutionMonthly PaymentUnpaid Balance Certify* By checking I certify that everything I have stated in this application is correct and authorize you to check my credit and employment history Best time to call?*FOR YOUR SECURITY, WE WILL CONTACT YOU TO COLLECT ADDITIONAL INFORMATION, SUCH AS SOCIAL SECURITY NUMBER, ETC.How did you hear about us?PhoneThis field is for validation purposes and should be left unchanged. 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