Consumer Loan Application - Susquehanna Community Bank

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*
Which Type of Loan?*
Which Type of Line of Credit?*
Purpose*
Amount*

Applicant Information
Applicant's Basic Information
Individual or Joint Account*
- Individual Account
- Joint Account
We 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 Initial
Last Name*
Suffix
Date of Birth*
MM slash DD slash YYYY

You must be 18 years of age or older to apply.
Email
Best Contact Telephone Number*
(###)###-####

Applicant's Housing Information
Current Address
Street Address City State ZIP Code
How Long at Current Address?*
Applicant's Monthly Housing Payment*
Own vs. Rent*
- Own
- Rent
Previous Address (complete if less than two years at present address)
Street Address City State ZIP Code
How Long at Previous Address?

Applicant's Additional Information
Applicant's Marital Status
- Married
- Separated
- Unmarried (including single, divorced, widowed)
Do not complete if this is an application for individual unsecured credit.
Secured Credit
Secured - Briefly describe the property that is to be given as security.
Owner/Co-Owner's Name of Collateral
Address
Street Address Address Line 2 City State ZIP Code
Owner/Co-Owner's Name of Collateral
Address
Street Address Address Line 2 City State ZIP Code
Spouse's Name

If Security is Real Estate, Provide the Full Name of Your Spouse (if any)
Nearest Relative Not Living with You
Name of Relative
Address of Relative
Street Address City State ZIP Code
Relationship
Phone
(###)###-####

Co-Applicant's Basic Information
First Name*
Middle Initial
Last Name*
Suffix
Date of Birth*
MM slash DD slash YYYY

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 State ZIP Code
How Long at Current Address?*
Best Contact Telephone Number*
(###)###-####
Co-Applicant's Employment Information
Present Employer Company Name*
Present Employer Address
Street Address City State ZIP Code
How Long at Present Employer?*
Position or Title
Wages*
Wages*
- Weekly
- Bi-Weekly
- Monthly

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?
Name
This field is for validation purposes and should be left unchanged.

Loan Information