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Loan Application

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Type of Credit Requested

Types of credit *

Individual Credit - Relying solely on my income or assets.

Individual Credit - Relying solely 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 * $

Proceeds of loan to be used for *

Individual Applicant Information

Last Name *

First Name *

MI *

Street Address *

City *

State *

Zip Code *

DOB (mm/dd/yyyy) *

Month

Day

Year

Social Security # *

Email Address *

Home Phone

Cell Phone *

Marital Status *

Married

Separated

Unmarried

Do Not Answer if this is for Individual Unsecured Credit

Member of the Armed Forces - Active Duty *

Are you a member of the armed forces who is serving on active duty or on active Guard or Reserve duty?

Dependent of a Member of the Armed Forces - Active Duty *

Are you a dependent of a member of the armed forces who is serving on active duty or on active Guard or Reserve duty?

Do You Rent or Own? *

Own

Rent

Monthly Housing Payment * $

Est. Home Value (if owned) $

How do you prefer to be contacted? *

Individual Applicant Employment Information

Employer Name *

Position / Title *

For How Long? *

Gross Salary * $ / year

Business Phone *

Street Address *

City *

State *

Zip Code *

Prior Employment

If you have been employed with your current employer less than one year, please provide your prior employment information below.

Prior Employer Name

For How Long?

Business Phone Number

Business Street Address

Business City

Business State

Busines Zip Code

Joint Applicant Information

Last Name

First Name

Street Address

City

State

Zip Code

DOB (mm/dd/yyyy)

Month

Day

Year

Social Security #

Email Address

Home Phone

Cell Phone

Marital Status

Married

Separated

Unmarried

Do You Rent or Own?

Own

Rent

Monthly Housing Payment $

Est. Home Value (if owned) $

Joint Applicant Employment Information

Employer Name

For How Long?

Joint Owner Gross Salary $ / year

Member of the Armed Forces - Active Duty

Are you a member of the armed forces who is serving on active duty or on active Guard or Reserve duty?

Dependent of a Member of the Armed Forces - Active Duty

Are you a dependent of a member of the armed forces who is serving on active duty or on active Guard or Reserve duty?

Business Phone Number

Business Street Address

Business City

Business State

Busines Zip Code

Prior Employment

If you have been employed with your current employer less than one year, please provide your prior employment information below.

Prior Employer Name

For How Long?

Business Phone Number

Business Street Address

Business City

Business State

Busines Zip Code

Electronic Signatures

Finishing Up

Location to finalize your loan? *

ELLINWOOD 211 East Santa Fe (Kim Miller)

GREAT BEND 2220 Broadway (Chuck Fellhoelter, Chuck Wilson, Shane Dicks)

HUTCHINSON 11th & Main 1020 N. Main Street (Michelle Inskeep, Janeishka Venegas)

HUTCHINSON 30th Street 601 E. 30th Avenue (Johannah Moore, Christine John)

INMAN 215 S. Main Street (Shane Williams)

LINDSBORG 201 S. Main Street (Ryan Biegert, Renella Sherwood, James Augusta)

LITTLE RIVER 310 Main Street (John Wempe, Haley Eck)

LYONS 101 E. Main Street (John Wempe, Haley Eck)

McPHERSON 101 S. Main Street (Chad Alexander, Jessi Moors, Mary Funk, Wayne Scheevel, Brad Bengtson, Zech Shiew, Gunner Whorton)

NESS CITY 210 South Kansas (Ray Witthuhn, Tonetta Stieben, Jeffery Wallgren)

NEWTON 123 E. Broadway St. Suite 101 (Melvin Schadler, Sal Lujano)

NICKERSON 76 N. Nickerson (Jennifer Gomes)

OTIS 112 South Main Street (Eric Anderson)

PLEASANTVIEW 6300 W. Morgan Avenue (Katie Johnson, Justin Hard)

WICHITA 11858 W 21st Street North (Jack Ronen, Kyle Welsh, Marcus Houghton)

YODER 9810 S. Main Street (Rynnell Schrag, Heather Howell)

Other Comments (optional)

FEDERAL CONSUMER CREDIT DISCLOSURES

CREDIT DISCLOSURES: An insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity: (1) The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliate(s); (2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, this institution, or our affiliate(s); and (3) In the case of an insurance product or annuity that involves an investment risk, there is investment risk associated with the insurance product, including the possible loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following; (1) Your purchase of an insurance product or annuity from us or any of our affiliates; or, (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity. .

Date (mm/dd/yyyy) *

Month

Day

Year

Primary Signature *

Joint Signature

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Math question * 5 + 1 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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