UCA 6-30-2003

CREDIT APPLICATION
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 the information. The information you provide is protected by our privacy policy and federal law.
TYPE OF CREDIT REQUESTED IMPORTANT: Check (x) the appropriate boxes below and complete the applicable sections SECURED INDIVIDUAL CREDIT - relying solely on my income or assets UNSECURED INDIVIDUAL CREDIT - relying on my income or assets as well as income or assets from other sources. JOINT CREDIT - We intend to apply for joint credit. (initials) __________________	FOR CREDITOR USE DATE _________ CLASS NO._____ ACCOUNT NO. ________________ APPROVED BY_____________ DECLINED BY______________

AMOUNT REQUESTED

$

FOR HOW LONG

PAYMENT DATE DESIRED

WANT TO REPAY
MONTHLY

PROCEEDS OF LOAN TO BE USED FOR:

SECTION A - INDIVIDUAL APPLICANT INFORMATION
NAME (Last, First, Middle)
BIRTH DATE	TELEPHONE NO.	DRIVER'S LICENSE NO.	SOCIAL SECURITY NO.	NO. DEPENDENTS	AGES OF DEPENDENTS

ADDRESS (Street, City, State & Zip)	COUNTY	Do you own or rent?	HOW LONG
PREVIOUS ADDRESS (Street, City, State & Zip) (Complete if less than 3 years at present address)	COUNTY	Did you own or rent?	HOW LONG
EMPLOYER (Company Name & Address)			HOW LONG

BUSINESS PHONE Ext.

POSITION OR TITLE

SALARY PER MONTH
GROSS: $ NET: $

PREVIOUS EMPLOYER (Company Name & Address)

HOW LONG

NAME & ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP TELEPHONE NO. (Include Area Code)
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
SOURCES OF OTHER INCOME	AMOUNT PER MONTH $
Is any income listed in this Section likely to be reduced before the credit request is paid off? No Yes (Explain)	Have you previously received credit from us? No Yes - When?

SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.
NAME (Last, First, Middle)
BIRTH DATE	TELEPHONE NO.	DRIVER'S LICENSE NO.	SOCIAL SECURITY NO.	NO. DEPENDENTS	AGES OF DEPENDENTS

RELATIONSHIP TO APPLICANT (If Any)	PRESENT ADDRESS (Street, City, State & Zip)	HOW LONG
EMPLOYER (Company Name & Address)		HOW LONG

BUSINESS PHONE Ext.

POSITION OR TITLE

SALARY PER MONTH
GROSS: $ NET: $

PREVIOUS EMPLOYER (Company Name & Address)

HOW LONG

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
SOURCES OF OTHER INCOME	AMOUNT PER MONTH $
Is any income listed in this Section likely to be reduced before the credit requested is paid off? No Yes (Explain)	Has Joint Applicant or Other Party ever received credit from us? No Yes - When?

SECTION C - MARITAL STATUS
Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying
on property located in such a state as a basis for repayment of the credit requested.

APPLICANT Married Separated Unmarried (including single, divorced, and widowed)
OTHER PARTY Married Separated Unmarried (including single, divorced, and widowed)

SECTION D - ASSET & 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 (Use separate sheet if necessary)
DESCRIPTION OF ASSETS	NAME IN WHICH THE ACCOUNT IS CARRIED	SUBJECT TO DEBT?	VALUE
CHECKING ACCOUNT NUMBER(S) (where)			$
SAVINGS ACCOUNT NUMBER(S) (where)
CERTIFICATE OF DEPOSIT(S) (where)
MARKETABLE SECURITIES (issuer, type, no. of shares)
REAL ESTATE (location, date acquired)
LIFE INSURANCE (issuer, face value)
AUTOMOBILES (make, model, year)
OTHER (list)
TOTAL ASSETS			$

OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages and other obligations. Use separate sheet if necessary.)
CREDITOR	ACCOUNT NUMBER	NAME IN WHICH THE ACCOUNT IS CARRIED	ORIGINAL AMOUNT	PRESENT BALANCE	MONTHLY PAYMENTS
LANDLORD OR MORTGAGE HOLDER	Rent Payment Mortgage		(OMIT RENT) $	(OMIT RENT) $	$
AUTOMOBILES (describe)






TOTAL DEBTS			$	$	$
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable): Are you obligated to make Alimony, Support or Maintenance Payments? No Yes If yes, to (Name & Address) ____________________________________________Amt. per month $__________________ Are you a co-maker, endorser, or guarantor on any loan or contract? No Yes If yes, for whom? ____________________________________ To whom? ______________________________________ Are there any unsatisfied judgments against you? No Yes If yes, to whom owed? _________________________________ Amount $______________________________________ Have you been declared bankrupt in the last 10 years? No Yes If yes, where? _______________________________________ Year? _________________________________________
SECTION E - SECURED CREDIT Complete only if credit is to be secured. Briefly describe the property to be given as security:
PROPERTY DESCRIPTION
NAMES & ADDRESSES OF ALL CO-OWNERS OF THE PROPERTY
IF THE SECURITY IS REAL ESTATE, GIVE THE FULL NAME OF YOUR SPOUSE (if any.)

SIGNATURES - I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By signing below I authorize Lender to check my credit and employment history and to answer questions others may ask Lender about my credit record with Lender. I understand that I must update credit information at Lender's request if my financial condition changes.

__________________________________________________________ ____________________________________________________
Applicant's Signature Date Other Signature (Where Applicable) Date