Personal Loan Application

Please feel free to call us at 540-896-8941 or visit one our local branches.
This application is for personal loans not secured by real estate.

Please choose the branch you prefer:
Check Appropriate Box: Individual Joint Co-maker for:
Loan Purpose:
If Refinance, Loan # and Payoff Amount
Amount: Term:
First Payment Date: Rate:
Collateral:
APPLICANT CO-APPLICANT
Name Name
Date of Birth SS# Date of Birth SS#
Age(s) of Dependent(s) Age(s) of Dependent(s)
Street Street
City/State/Zip City/State/Zip
Mailing Address (if different) Mailing Address (if different)
How Long? Own Rent How Long? Own Rent
If Owned, Cost: Mo. Payment If Owned, Cost: Mo. Payment
Value: Value:
Home Phone Business Phone Home Phone Business Phone
E-Mail Address E-Mail Address
Previous Address (if less than 2 years) Previous Address (if less than 2 years)
Street Street
City/State/Zip City/State/Zip
Employer Name Self Employed Employer Name Self Employed
Employer Address Employer Address
How Long? Position How Long? Position
Gross Mo. Pay $ Net Mo. Pay $ Gross Mo. Pay $ Net Mo. Pay $
Other Income* Other Income*
Previous Employer and Address (if less than 2 years) Previous Employer and Address (if less than 2 years)
How Long? Title How Long? Title
Monthly Income $ Monthly Income $
*Notice: Alimony, child support, or separate maintenance income need not be revealed if an Applicant does not choose to have it considered as a basis for repaying this loan.
LIABILITIES
Current obligations including banks, finance companies, department stores and credit cards. Indicate debts of Applicant with an "A" and debts of Co-applicant with a "C". Indicate debts on which both are jointly obligated with a "J".
First Mortgage - Financed by: Account Number A/C/J Mo. Pmt. Balance
Second Mortgage - Financed by: Account Number
Auto Yr & Make Financed by:
Auto Yr & Make Financed by:
Other Debts - Purpose Financed by:
Are you Guarantor or Co-Signer For Anyone? Yes No
(If Yes, List):
SCHEDULE OF OTHER REAL ESTATE OWNED
Location and Type of Property Owned by A/C/J Name of Lender and Account # Date Acquired Purchase Price Current Value Mo. Rental Income Mo. Pmt. Mortgage
Balance
MISCELLANEOUS INFORMATION (Indicate (A), (C) or (J) as appropriate.)
Face Amount of Life Insurance Banking Relationships - Name of Bank
Company Checking Acct. # Bal.
Value of Stocks & Bonds Savings Acct. # Bal.
MISCELLANEOUS INFORMATION (Indicate (A), (C) or (J) as appropriate.)
Name and Address of Nearest Relative Not Living With You (Applicant) Relationship Phone
Name and Address of Nearest Relative Not Living With You (Co-applicant) Relationship Phone
Has either Applicant ever been party to any suits, judgments, garnishments, bankruptcy or other legal proceedings? Yes No
If Yes, give particulars:
You may check my credit and employment history and answer questions about your credit experience with me. Everything I have stated in this application is correct and accurate to the best of my knowledge. Under penalties of perjury, I certify that I have provided my correct Social Security Number (Taxpayer Identification Number), and that I am not subject to Internal Revenue Service backup withholding. Name and Taxpayer Identification Number of Applicant will be used for IRS information reporting, if applicable.
205 S. Main St.     P.O. Box 1111     Timberville, VA 22853     (540) 896-8941