Applicant
Information
Social
Security Number
*
Date of Birth
M/D/Y
*
Name (First, Middle, Last)
* Street Address
*
U.S. Citizen
Yes
No
*
City
*
State
*
Zip
*
Years at Residence
Work
Phone
Cell Phone
*
Home Phone
Mortgage
Holder
*
Mortgage/Rent
Payment
Employer
*
Job Title/Position
*
Salary (Gross) Per:
$
*
Length of
employment
*
E-Mail
Fax
Home
Value
$
Other
Income (alimony, child support, maintenance
payments need not be revealed if you do not wish to
rely upon such income for approval)
Source
of Other Income
$
Co-Applicant
(optional)
Date of Birth - M/D/Y
Name (First, Middle,
Last)
*
U.S. Citizen
Yes
No
Employer
Job Title/Position
Salary
(Gross) Per:
Length of employment
Home Phone
Work Phone
$
Other Income
(alimony, child support, maintenance payments need not
be revealed if you do not wish to rely upon such income
for approval)
Source of Other Income
$
RV
Information
*
Manufacturer
*
Model
*
Year
*
Length
*
Purchase
Refinance
New
Used
Chassis
Mileage
#of Slide Outs
Engine Make
Use
Pleasure
Principle Dwelling
Type
Motor Home
5th Wheel
Travel Trailer
Other
Fuel
HP
*
Purchase Price w/sales tax
Down
Payment
Gas
Diesel
$
$
*
Loan Amount Requested
*
Terms Requested
$
Financial
Information
Assets
please do
not use commas
when entering dollar amounts
*
Cash, Investments, & Securities
*
401K, IRA, Retirement
*
Real Estate Value - Primary Residence
*
Real Estate Value - Second Home
*
Real Estate Value - Rental Property
Current
RV Value
*
Other Assets including Automobiles & Boats
Total$
Liabilities
please do not use commas
when entering dollar amounts
Lending Institution
Monthly Payment
*
Credit Cards
*
Auto & Boat Loans
*
Other Liabilities
*
Primary Residence Loan
*
Second Home Loan
* Rental Property Loan
*
Current RV Loan
*
Notes Payable
Total$
* Net
Worth (Assets minus Liabilities) $
* How did you find out
about us?
Additional Comments?
I/we acknowledge that I/we have made this application
with the intent that you should rely upon the information
contained herein in granting the credit requested.
I/we understand that, if the requested credit is granted,
you may report information concerning the credit to
consumer reporting agencies and to others. I/we affirm
that my/our answers are complete and true and authorize
you to verify or obtain any information concerning
them. Upon your request, I/we further authorize any
firm or individual from whom I/we may have obtained
or requested credit, to furnish you with the details
of that transaction. I/we also agree to provide current
financial information upon request, in a form acceptable
to you.
* Signature of Applicant
(please type your last name in the box):
Signature of Co-Applicant (if applicable) (please
type your last name in the box):
If you wish to submit this information on-line, click
the "submit" button at the bottom of the
page. If you prefer to fax this form, click print
and fax it to 410-268-3755.
Note to applicant: This prequalification is based
purely on information provided to us by you. Verification
of this information by us and additional information
consisting of your last two years federal tax returns
including schedules A-E may be required in order to
issue an actual loan commitment. Please fax them to:
410-268-3755.
PATRIOT ACT CUSTOMER IDENTIFICATION
The U.S. government, in order to fight the funding
of terrorism and money laundering, has issued a
law requiring all financial institutions to obtain,
verify and record information that identifies each
person who opens an account. In addition to the
information on our application, please also provide
your drivers license number, issue and expiration
date, and the state that it was issued. We thank
you for your cooperation.