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Consumer Loan Application

Purpose of Loan*
Amount of Loan*
$
# of Months
Please do    do not charge my checking account automatically for payments Account #:

Section A - PRIMARY APPLICANT
Last Name *
First Name*
Initial
Social Security Number*
Date of Birth*
Present Street Address*
City*
State*
Zip*
How Long?
Home Phone Number
Cell Phone Number
Email Address*
* Own    Rent
  Other
Monthly Rent or Mortgage Payment*
$
Previous Address (if less than 3 years)
City

State
Zip
How Long?
Present Employer*
Position
How Long?*
Gross Monthly Wage*
$
Employer's Phone Number
Previous Employer
Position
How Long?
Gross Monthly Wage
$
Previous Employer's Phone Number
Income from alimony, child support, or separate
maintenance payments need not be revealed if you
do not choose to have it considered as a basis for
repaying this obligation.
Source of Other Income
Amount of Other Income
$
Monthly    Yearly
Name of nearest relative (not living with you)
Relationship
Home Phone Number
Mother's Maiden Name

Section B - JOINT APPLICANT
Last Name
First Name
Initial
Social Security Number
Date of Birth
Present Street Address
  City
State
Zip
How Long?
Home Phone Number
Cell Phone Number
Email Address
Own    Rent
Other
Monthly Rent or Mortgage Payment
$
Present Employer
Position
How Long?
Gross Monthly Wage
$
Employer's Phone Number
Previous Employer
Position
How Long?
Gross Monthly Wage
$
Previous Employer's Phone Number
Income from alimony, child support, or separate
maintenance payments need not be revealed if you
do not choose to have it considered as a basis for
repaying this obligation.
Source of Other Income
Amount of Other Income
$
Monthly    Yearly

ASSETS DEBTS
DESCRIPTION VALUE OWNER MONTHLY PAYMENTS PAID TO WHOM CURRENT
BALANCE
MONTHLY
PAYMENT
Cash in Financial Institutions $ $ $
Marketable Securities $ $ $
Retirement Accounts $ 1st Mortgage/Rent $ $
Home $ 2nd Mortgage/HECL $ $
Other Real Estate $ Other Mortgage $ $
Automobile $ Vehicle Loan $ $
Automobile $ Vehicle Loan $ $
Life Insurance
(Face $ )
$ Credit Cards (List) $ $
Other Assets (List)
$   $ $
$ Other $ $
$ Alimony/Child Support $ $
TOTAL ASSETS $   TOTAL LIABILITIES   $ $
      NET WORTH: (ASSETS MINUS LIABILITIES) $  

RIGHT TO RECEIVE A COPY OF APPRAISALS. We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close. You can pay for an additional appraisal for your own use at your own cost.

Are any of the assets listed above held in a trust? Yes No           Have you ever filed for Bankruptcy? Yes No

In connection with this application for credit the applicant authorizes and requests all persons listed above and all Consumer Reporting Agencies to furnish Brighton Bank Consumer Reports and/or Investigative Consumer Reports on this applicant.

I certify that the information, including the listing of all debts, given on this application is true, complete and correct to the best of my knowledge. I understand that Brighton Bank will rely on the truthfulness and completeness of the foregoing statements in granting credit to the applicant. (NOTE: FALSIFICATION OF CREDIT INFORMATION TO THE BANK IS A CRIMINAL VIOLATION OF FEDERAL AND UTAH LAW).

I am applying for individual credit.
We are applying for joint credit.

FOR JOINT CREDIT, INITIAL HERE: Borrower     Co-Borrower

– I/We certify that the information on this application is true and complete to the best of my/our knowledge. The Brighton Bank is authorized to verify, exchange and retain credit and employment information contained herein and relative to this application.

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