Liberty Bank


OnLine Credit Application!

Being a REAL community bank, Liberty Bank normally restricts its loans to a 10-15 mile radius of our four community banking centers in Liberty, Barry, Payson, and Quincy, Illinois. If you would like to apply for a loan with us, please fill out the following credit information, print it out and sign it, and bring it to us at our office which is nearest to you. Our professional loan officers will follow up with you quickly to analyze your loan request. Depending on the type of loan you are requesting, additional information may be requested from you to complete the application process, but this will give us a great place to start. Our goal is to help our loan customers get what they need and then get them out of debt as quickly as possible and turn them into major depositors!! You can do it with our expert help!! If you have any questions regarding this application, please call 1-217-645-3434 and ask for Customer Service.


Loan Amount requested:

$ __________________

Purpose of Loan:

 ____________________________________

 

INFORMATION REGARDING APPLICANT

Section A - APPLICANT INFORMATION

Section B - CO-APPLICANT (if applicable)

First Name

__________________

First Name

__________________

MI

__________________

MI

__________________

Last Name

__________________

Last Name

__________________

Birthdate:

__________________

Birthdate:

__________________

Social Security Number

__________________

Social Security Number

__________________

Present Street Address

____________________________________

Present Street Address

____________________________________

City __________________ State ____

City __________________ State ____

Zip

___________ - ___________

Zip

___________ - ___________

Years there

__________________

Years there

__________________

Telephone #

__________________

Telephone #

__________________

Driver's License

__________________

Driver's License

__________________

Previous Street Address

__________________

Previous Street Address

__________________

City __________________ State _____

City __________________ State _____

Zip

___________ - ___________

Zip

____________ - ____________

Years there

_____________

Years there

_____________

Present Employer

____________________________________

Present Employer

____________________________________

Address

____________________________________

Address

____________________________________

City __________________ State _____

City __________________ State _____

Zip

___________ - ___________

Zip

____________ - ____________

Years there

__________________

Years there

__________________

Telephone

__________________

Telephone

__________________

Position or title

__________________

Position or title:

__________________

Name of supervisor

__________________

Name of supervisor

__________________

Previous Employer

____________________________________

Previous Employer:

____________________________________

Previous Employer's Address

____________________________________

Previous Employer's Address

____________________________________

City __________________ State _____

City __________________ State _____

Zip

________ - _____

Zip

_________ - _____

Present net salary or commission per month:

$ __________________

Present net salary or commission per month:

$ __________________

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.

__________________

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.

__________________

Alimony, child support, separate maintenance received under:

__________________ court order
__________________ written agreement
__________________ oral understanding.

Alimony, child support, separate maintenance received under:

__________________ court order
__________________ written agreement
__________________ oral understanding.

Other income:

$ __________________

Other income:

__________________

Other income source:

____________________________________

Other income source:

____________________________________

Is any income listed in this Section likely to be reduced before the credit requested is paid off?

__________________ Yes No

Is any income listed in this Section likely to be reduced before the credit requested is paid off?

Yes No

Name of nearest relative not living with you

____________________________________

Name of nearest relative not living with you

____________________________________

Relationship

____________________________________

Relationship

____________________________________

Address

____________________________________

Address

____________________________________

City __________________ State _______

City __________________ State _______

Zip

____________ - _______

Zip

____________ - _______

Telephone

__________________

Telephone

__________________

 

Checking Account #

__________________

Checking Account #

__________________

Institution and Branch

____________________________________

Institution and Branch

____________________________________

Savings Account #

__________________

Savings Account #

__________________

Institution and Branch

____________________________________

Institution and Branch

____________________________________

Please complete if you've received credit with us.

Date of Loan Approval

____________

Date of Loan Approval

____________

SECTION C- MARITAL STATUS
(Do not complete if this is an application for individual unsecured Credit.)

Applicant

Married
Separated
Unmarried (including single, divorced, and widowed)

Other Party

Married
Separated
Unmarried (including single, divorced, and widowed)

SECTION D - ASSET AND DEBT INFORMATION

(If Section B has been completed, this Section should be completed giving information about both the Applicant and Joint Applicant or Other Person. Please mark Applicant-related information with an "A." If Section B was not completed, only give information about the Applicant in this Section.)

Assets Owned

Description of Assets

Value

Subject to Debt?

Names(s) of Owner(s)

Cash

$ __________________

Yes
No

____________________________________


____________________________________

Automobiles (Make, Model, Year)

____________________________________

$ _____________

Yes
No

__________________

__________________

$ __________________

Yes
No

____________________________________

Cash Surrender Value of Life Insurance
Issuer: ____________________
Face Value: ____________________

$ __________________

Yes
No

__________________

Real Estate

Location __________________


Date Acquired
__________________

$ __________________

Yes
No

__________________

Location __________________


Date Acquired
__________________

$ __________________

Yes
No

__________________

Marketable Securities

Issuer __________________


Type ____________________


No. of Shares ____________

$ __________________

Yes
No

__________________

Issuer __________________


Type ____________________


No. of Shares ____________

$ __________________

Yes
No

__________________

Other

$ __________________

Yes
No


__________________

Other

$ __________________

Yes
No

__________________

Total Assets

$ __________________

 

 

OUTSTANDING DEBTS
(Include charge accounts, installment contracts, credit cards, rent, mortages, etc.)

Creditor

Type of Debt.or Acct. No.

Original Debt

Present Balance

Monthly payments

Past Due?

(Landlord or Mortgage Holder)
___________

Rent Payment
Mortgage

(Omit Rent)
$ ____________

(Omit Rent)
$ ____________

$ ____________

Yes
No

Credit Cards __________________

__________________

$ ____________

$ ____________

$ ____________

Yes
No

Credit Cards __________________

__________________

$ ____________

$ ____________

$ ____________

Yes
No

Medical __________________

__________________

$ ____________

$ ____________

$ ____________

Yes
No

Other ________________

__________________

$ ____________

$ ____________

$ ____________

Yes
No

Total Debts

$ ____________

$ ____________

$ ____________

Yes
No

Additional Credit References

Date Paid

____________

__________________

$ ____________

$ ____________

$ ____________

__________

________________________

__________________

$ ____________

$ ____________

$ ____________

_________

Are you a co-maker, endorser, or guarantor on any loan or contract?

Yes for $ ________
No

To whom? ________________________

Are there any unsatisfied judgments against you?

Yes $ ________
No

To whom? ________________________

Have you been declared bankrupt in the last 14 years?

Yes where? ________
No

Year _________

Other obligations - (E.g., liability to pay alimony, child support, separate maintenance.)

________________________

 

Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

 
 
 
 

Borrower's Signature

Date

Co-Borrower's Signature

Date

Loans for residential real estate may require a more detailed application. Please call or visit for additional information.

Please enter information, print the form and visit your nearest location:

LIBERTY BANK
1002 North Main
Liberty, IL 62347

Barry Community
Banking Center
PO Box 132
Barry, IL 62312

Payson Community Banking Center
402 West State Street
Payson, IL 62360

Quincy Community
Banking Center
4134 Broadway Street
Quincy, IL 62305

Liberty Bank
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