Consumer Application

First State Bank - Lynnville, Iowa

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* Indicates a required field

Type of Credit Requested

Applicant Information

Joint Applicant or Other Party Information

Asset and Debt Details

Signature

Important Applicant Information: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances, we may use outside sources to confirm this information. The information you provide is protected by our privacy policy and federal law.

Type of Credit Reqested:

Secured

Unsecured

Individual Credit - relying solely on my income and assets.

Individual Credit - relying on my income or assets as well as income or assets from other sources.

Joint Credit - we intend to apply for joint credit.

Amount Requested ($):

Term (months):

Payment Date Requested:

Loan Purpose:

Property Description: