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Consumer Loan Application
In order to print the Consumer Loan Application, you will need Adobe Acrobat Reader

If you don't have Acrobat Reader, you can download it HERE.

Printable Version of the Consumer Loan Application

Applicant(s) Check one of the following boxes. You may apply for separate or joint credit.
Separate Credit. Complete column 1.
If you are married and a Wisconsin resident, you must complete column 2 with information about your spouse.

Joint Credit with spouse. Complete columns 1 and 2.
Joint Credit with , who is not your spouse.
Each of you must complete an application as if applying for separate credit and submit them together, including completing column 2 if you are married and a Wisconsin resident.

Amount requested $
Purpose

Email Address

Column 1 - Applicant
White filler text
Name
Marital Status Married
Marital Status Legally Separated
Marital Status Unmarried (Single, Widowed, Divorced)
Year of Marriage:
 
Social Security Number
Drivers License No.:    State:
Date of Issue:    Exp. Date:
Date of Birth
Home Phone #
No. of Dependents Ages
Home Address
City State Zip
County How Long (yrs)
Previous Address
City State Zip
How Long (yrs)
Employer Name
Employer Address
Business Phone
Occupation
How Long (yrs)
Gross Income (before taxes) Mo Yr
Previous Employer
Other Income (Except Alimony, Child Support and Maintenance)
$ MO Yr
Name, Address of Nearest Living Relative (Not living with you)
Income From Alimony, Child Support or Separate Maintenance Payments (Need not be revealed if applicant(s) does not choose to rely on such income.

Kind of Income

Name of Payer
Amt per Month $ Ends MO Yr 20
Amt Past Due $
Have you ever been bankrupt, surrendered collateral, or had it repossessed, or had or have any judgment or other legal proceedings against you?
Yes
No
If Yes, please give details:
Is any listed income likely to be reduced before the credit requested is paid off?
Yes
No
If No, please give details:

Column 2 - Spouse

Co-Applicant (Joint Credit) Non-Applicant
Name
Marital Status Married
Marital Status Legally Separated
Marital Status Unmarried (Single, Widowed, Divorced)
Year of Marriage:
 
Social Security Number
Drivers License No.:    State:
Date of Issue:    Exp. Date:
Date of Birth
Home Phone #
No. of Dependents Ages
Home Address
City State Zip
County How Long (yrs)
Previous Address
City State Zip
How Long (yrs)
Employer Name
Employer Address
Business Phone
Occupation
How Long (yrs)
Gross Income (before taxes) MO Yr
Previous Employer
Other Income (Except Alimony, Child Support and Maintenance)
$ MO Yr
Name, Address of Nearest Living Relative (Not living with you)
Income From Alimony, Child Support or Separate Maintenance Payments (Need not be revealed if applicant(s) does not choose to rely on such income.to rely on such income.

Kind of Income

Name of Payer
Amt per Month $ Ends MO Yr 20
Amt Past Due $
Have you ever been bankrupt, surrendered collateral, or had it repossessed, or had or have any judgment or other legal proceedings against you?
Yes
No
If Yes, please give details:
Is any listed income likely to be reduced before the credit requested is paid off?
Yes
No
If No, please give details:
Bank Checking Savings
Other Investments/Assets
Do You : Own Rent Live with relatives .................... Monthly Payment $
Mortgage Holder or Landlord Market Value of Home $ Mortgage Balance $
Are you obligated to pay child support or alimony? Yes No ....... If Yes, How much $
When does this obligation end?

List all other debts including vehicle loans, leases, all credit card accounts, installment loans, student loans, home equity loans, etc. :

Creditor Name
Collateral
Remaining Balance
Monthly Payment
$
$
$
$
$
$
$
$
$
$
$
$
$
$

NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under s766.59, Wis. Stats. or court decree under s766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted or and open-end credit plan is entered into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.

NOTICE OF RIGHT TO RECEIVE COPY OF APPRAISAL: Under the Federal Equal Opportunity Act, if the credit being applied for will be secured by a 1-4 family dwelling, you have the right to a copy of the appraisal report used in connection with your application. If a coy was not already provided to you and you wish a copy, please write to the creditor at the address on the face page of this application. Be sure to include your name and address. The creditor must hear from you no later than ninety (90) days after it notifies you about the action taken on your application or you withdraw your application. In order to receive a copy of the appraisal report, you must also have paid for the appraisal and the costs of photocopying the report.
 
For the purpose of obtaining the credit described above, and any future credit granted to the undersigned by the creditor named above, the undersigned, jointly and severally, (1) represent that the above statements are true and complete, (2) authorize the creditor named above, or it's agents, to verify them and obtain additional information concerning our credit, employment history or any other information, including credit reports (althought creditor may rely on these statements without any further verification), to furnish such information and any other credit experience with me to others, and to answer any questions about our credit experience and other financial relationships with the creditor, and (3) agree to the provisions of any rules, regulations or agreements of the creditor named above governing such credit. This application is creditor's property. The creditor may share information bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living with its affiliates unless I direct the creditor at the address above that such information if unrelated to my transactions or experiences with the creditor may not be shared by the creditor with its affiliates.

NOTICE: REPORTING NEGATIVE INFORMATION TO CREDIT BUREAUS - We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.

The undersigned understand that it may be a federal crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts, under the provision of Title 18, United States Code, Section 1014.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OBTAINING CREDIT
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 obtains credit.
What this means for you: when you obtain credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying information.


Applicant's Name: Date:
CO-Applicant Spouse Name: Date:

For Married Wisconsin Resident:
The credit being applied for, if granted, will be incurred in the interest of my marriage or family. I understand the creditor may be required by law to give notice of this credit transaction to my spouse.

Applicant's Name: Date:

 

The information that is entered on this form, when submitted, is transmitted via the world wide web. Wood County National Bank can not guarantee the privacy of this information from illegal intrusion during the transmission.

 
 
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