Loan Inquiry

Loan Information

Applicant Information

Debts

Agreement

Loan Information
- Loan Amount *
- Payment Method *
- Application Type *
  Individual Joint
Applicant Information
- First Name *
- Last Name *
- Date of Birth *
- Social Security Number *
- Driver's License Number
- Drivers License State
- Home Phone *
- Cell Phone
- Work Phone *
- Email
- Preferred Contact Method *
- Address *
- Address
- City *
- State *
- Zip *
- Housing Type*
- Years and Months at address *
- Mortgage Holder or Landlord Name
- Monthly rent or board
- Mortgage Balance
- Mortgage Payment
- Previous Address
- Previous Address
- Previous City
- Previous State
- Previous Zip
- Self Employed *
  Yes No
- Job Title
- Employer Name *
- Employer Address *
- Employer City *
- Employer State *
- Employer Zip
- Years and months at job
- Gross salary per pay period
- Pay frequency*
- Previous Employer Name
- Previous Employer Address
- Previous Employer City
- Previous Employer State
- Previous Employer Zip
- Previous Years and months at job
- Additional Income
- Other Income Source
- Additional Income Gross Monthly Amount
- Pay frequency
- Creditor Name
- Liability Type
- Account Number
- Loan Balance
- Monthly Payment
- Creditor Name
- Liability Type
- Account Number
- Loan Balance
- Monthly Payment
- Date Purchased
- Purchase Price
- Current Market Value
- In whose name
- Year, Make & Model
- Financed By
- Balance Owning
- Monthly Payment
- Year, Make & Model
- Financed By
- Balance Owing
- Monthly Payment
- Do you have any outstanding judgments? *
  Yes No
- Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?*
  Yes No
- Have you had property foreclosed upon or repossessed in the last 7 years?*
  Yes No
- Are you other than a U.S. Citizen or permanent resident alien? *
  Yes No
- Is your income likely to decline in the next two years? *
  Yes No
- Are you a co-maker, co-signer or guarantor on any loan not listed above? *
  Yes No
- If yes, what is the monthly payment *
- Are you liable for alimony, child support or maintenance programs? *
  Yes No
- If yes, what is the monthly payment *
I/We agree to the terms and conditions of the Account Agreement, Truth-in-Savings Disclosure, Funds availability Policy Disclosure, if applicable, and to any amendment the Bank makes from time to time which are incorporated herein. I/We acknowledge receipt of a copy of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
- Authorization for a credit check *
  By clicking this box, I/We give Bank of Wolcott authorization to run a credit report.
- Primary Applicant Date *
- Joint Applicant Date *