Credit Application

Clare Bank Credit Application
Instructions:

Please feel free to print out this form and mail to:
Clare Bank
345 W. Pine Street, Platteville, WI 53818

Use this form to apply to Clare Bank for Loans
When finished click on the send button

Loan Application to: Clare Bank
This Bank is an Equal Opportunity Lender.

1. Type and Terms of Loan

Amount Requested: $	Purpose of Loan:	Term of Loan Requested:
To be secured by collateral: No Yes	If yes, describe collateral

2. Borrower Information

		OPTIONAL - Answer only if co-applicant desires
1. Will there be a Co- Applicant? Yes No	2. Will Applicant rely on income of Co-Applicant as a basis for repayment of this loan? Yes No	3. Will applicant rely on income from: Alimony Under Court Order Child Support Written Agreement Separate maintenance Oral Agreement		as a basis to repay this loan? Yes No Amount to be received monthly: $	If Applicant has answered "Yes" to any questions in 1, 2, or 3 please complete Co-Applicant Section

Co-Applicant Guarantor

Applicant	Co-Applicant
Name:	Name:
Marital status: Married Unmarried Separated	Marital status: Married Unmarried Separated
Social Security Number:	Social Security Number:
Date of Birth:	Date of Birth:
Number of Dependents:	Number of Dependents:
Home Address:	Home Address:
City, State, Zip:	City, State, Zip:
Home Phone No.:	Home Phone No.:
How Long at this address?: Yrs. Mo.	How Long at this address? Yrs. Mo.
Former Home address:	Former Home address:
City, State, Zip:	City, State, Zip:
Years at this address?: Yrs. Mo.	Years at this address?: Yrs. Mo.

3. Employment Information

Applicant	Co-Applicant
Employed by:	Employed by:
Position:	Position:
How Long?: Yrs. Mo.	How Long?: Yrs. Mo.
Business address:	Business address:
City, State, Zip:	City, State, Zip:
Business Phone:	Business Phone:
Monthly Salary (Gross): $	Monthly Salary (Gross): $
(If less than two years with present employer)
Former Employer:	Former Employer:
Position:	Position:
How Long?: Yrs. Mo.	How Long?: Yrs. Mo.
Former Employer address:	Former Employer address:
City, State, Zip:	City, State, Zip:
Business Phone:	Business Phone:
Monthly Salary (Gross): $	Monthly Salary (Gross): $
Name of my Bank:	Name of my Bank:
City, State:	City, State:
Checking Savings	Checking Savings

4. Debts:

1. Creditor:	Name of Creditor:
Address:	Address:
Date Incurred: Collateral:	Date Incurred: Collateral:
Unpaid Balance: $ Monthly Pay: $	Unpaid Balance: $ Monthly Pay: $
2. Creditor:	Name of Creditor:
Address:	Address:
Date Incurred: Collateral:	Date Incurred: Collateral:
Unpaid Balance: $ Monthly Pay: $	Unpaid Balance: $ Monthly Pay: $

5. References

Name of Relative not living with you:	Relationship:
Relative's Address:	City, State:
	Relative's phone:

6. Other Income
(excluding alimony, child support, or separate maintenance)

Source:

Other monthly income: $

Notice to Married Applicants Living in Wisconsin
No provision of any marital property agreement, unilateral statement under section 766.59 of the Wisconsin Statutes, or court order under section 766.70, adversely affects the interest of Clare Bank unless Clare Bank is furnished a copy of the agreement, statement, order, or has actual knowledge of the adverse provision before opening the requested account.

By submitting, I certify that the above information is true and correct.

We'd like your feedback.
E-mail us at Mail@ClareBank.com