Loan Request

 
Check here if you are applying for individual credit in your own name, are not married, and are not relying on alimony, child support, or separate maintenance payments or the income or the assets of another person as the basis for repayment of credit requested.
 
Check here in all other situations and provide information about a joint applicant or user, or the person on whose alimony, support, or maintenance payments or income or assets you are relying.

Loan Officer

If there is a City Bank Loan Officer you would like to reference for this application, please enter their name here.

First Name
Last Name

Type of requested credit

Tell us a little about the type of loan you’d like to request.
Amount Requested
   
Duration of Loan
in Months
 
Requested Payment Date
 
 
Type of Loan
 

Applicant Information

Please provide the following information about the potential borrower.
First Name
 
Middle
Last Name
 
Drivers License No.
or Govt. ID
   
Issuing State
 
Date of Birth
 
 
 
Social Security No.
   
Primary Phone No.
   
Secondary Phone No.
 
Email Address
   
Marital Status
 
Present Address
 
 
Street
 
City
 
State
 
Zip
   
Monthly Mortgage or Rent Payment Amount
 

Employment

Please provide the required employment information.
Employer
 
Status
 
 
Phone
   
Address
Street
 
City
 
State
 
Zip
   
Gross monthly salary/commission
 
Position/Title
 
Type of work
Please describe your self-employed line of work.
 

Additional Income

Please list any other sources of 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.
Source
Gross monthly amount
Source
Gross monthly amount
Source
Gross monthly amount

Nearest Relatives

Please provide two references not living with you.
First Name
 
Middle
Last Name
 
Primary Phone No.
   
Address
Street
 
City
 
State
 
Zip
   
First Name
 
Middle
Last Name
 
Primary Phone No.
   
Address
Street
 
City
 
State
 
Zip
   
 

For pre-approval purposes only. This is not a commitment to lend. Upon receiving the submitted information, it will be reviewed and you may be contacted to continue the credit application process needed to complete a loan request.

Credit Application Disclosure

Privacy Policy Notice: Nonpublic personal information collected about you from this application and other sources, including a credit report, may be disclosed to persons within this institution or our affiliates, if any, as permitted or required by law. A copy of our privacy policy is available upon request. A consumer may obtain a copy of our privacy policy by calling or visiting our financial institution during regular business hours to request a copy of our privacy policy.

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.

Special Notice: Consumer loans may have a $50.00 administrative fee for Texas applications and a $25.00 administrative fee for New Mexico applications.

Federal credit application insurance disclosure: I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance product or annuity in connection with this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING THE EXTENSION OF CREDIT ON EITHER:
1. My purchase of an insurance product or annuity from you or from any of your affiliates; or
2. My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity.

Signatures: By agreeing to these terms and “submitting,” I acknowledge that I have received a copy of this form on today’s date. Unless the aforementioned disclosures are provided electronically or I have applied for credit by mail, I also acknowledge that you have provided these disclosures for me orally. I certify that everything I have stated in this application is correct. City Bank may keep this application whether or not it is approved. By submitting this application I authorize City Bank to check my credit and employment history and to answer questions others may ask City Bank about my credit record with City Bank. I understand that I must update credit information at City Bank’s request if my financial condition changes.