Consumer Loan Application

Please fill out the fields in the form below. One of our lenders will contact you within one business day. In order to finalize this process you will be asked to present your photo ID and sign all necessary documents in person.

If you are applying for a First Lien Mortgage please click here https://mortgage.maquoketasb.bank/
* = Required field

Type of Application

Individual

Joint / With Co-Applicant

Amount Requested

Payment Date Desired

Proceeds of Credit To Be Used For

Property to be used as collateral (include make and model if applicable)

Section A - Applicant Information

Marital Status

Do not complete this if this is an Application for an unsecured individual account.

Number of Dependents

First Name

Last Name

Street Address

City

State

ZIP

Do You

Own

Rent

Number of Years at Current Address

Monthly rent or mortgage payment

Primary Phone

Secondary Phone

Birth Date

Identification

Driver's License

Military

State ID

ID#

State

Date Issued

Expiration Date

Employment Information

Employment Status

I am Employed

I am Retired

I am Unemployed

Employer

Occupation

Business Phone

Hire Date

Income

Income Type

Monthly Salary

Hourly Rate

Other Income

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Describe

Amount

Declarations
Obligated to pay alimony, child support, or separate maintenance? Yes No
Are you a co-maker or endorser on any loan or contract? Yes No
Are there any unsatisfied judgements against you? Yes No
Have you been declared bankrupt in the last 10 years? Yes No
Have you previously received credit from us? Yes No
Are you a US citizen? Yes No

Nearest Relative Not Living With You

First Name

Last Name

Relation

Phone Number

Street Address

City

State

ZIP

Section B - Joint Applicant / Co-Applicant Information

Marital Status

Do not complete this if this is an Application for an unsecured individual account.

Number of Dependents

First Name

Last Name

Street Address

City

State

ZIP

Do You

Own

Rent

Number of Years at Current Address

Monthly rent or mortgage payment

Primary Phone

Secondary Phone

Birth Date

Identification

Driver's License

Military

State ID

ID#

State

Date Issued

Expiration Date

Employment Information

Employment Status

I am Employed

I am Retired

I am Unemployed

Employer

Occupation

Business Phone

Hire Date

Income

Income Type

Monthly Salary

Hourly Rate

Other Income

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Describe

Amount

Declarations
Obligated to pay alimony, child support, or separate maintenance? Yes No
Are you a co-maker or endorser on any loan or contract? Yes No
Are there any unsatisfied judgements against you? Yes No
Have you been declared bankrupt in the last 10 years? Yes No
Have you previously received credit from us? Yes No
Are you a US citizen? Yes No

Section C - Assets and Debts

Assets

Owned Home

Vehicle(s)

Cash (Checking, Savings)

Other

Use this form to input information about your creditors

I have no established credit

Creditors

Re-order	Name of Creditor	Current Balance	Monthly Payment	Weight	Operations
	Name of Creditor	Current Balance	Monthly Payment	Item weight

more items

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Consumer Loan Application

Employment Information

Other Income

Nearest Relative Not Living With You

Employment Information

Other Income

Assets

Use this form to input information about your creditors

Contact Information

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

REQUEST FOR DEMOGRAPHIC INFORMATION OF BORROWER

Credit Authorization *

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