Loan Application
Purpose: Details of Purpose: Joint Application Date
Business Yes
Agriculture No Amount Requested
Personal Secured
Unsecured  
Source Of Repayment
Primary: Auto Debit? DCB Account Number:
Secondary: Yes No
Primary Applicant Information
Full Name: Birthday: SSN#: DL#:
Mailing Address (include City, St, & Zip): Home Phone: Rent Issue Date:
Own

Physical Address (include City, St, & Zip):

Work Phone: How Long: Exp. Date:
E-Mail Address:
Joint Applicant Information (if applicable)
Full Name: Birthday: SSN#: DL#:
Mailing Address (include City, St, & Zip): Home Phone: Rent Issue Date:
Own
Physical Address (include City, St, & Zip): Work Phone: How Long: Exp. Date:
E-Mail Address:
**** Guarantor? No    Yes - If yes, please complete separate application
Employment Information
Primary Applicant Joint Applicant (if applicable)
Employer: How Long: Employer: How Long:
Address:   Address:  
Position:   Position:  
Previous Employer:   Previous Employer:  
Address:   Address:  
Personal References
Name: Address: Phone: Relationship:
Collateral Information
Describe Collateral: Year: Make/Model: ID #:
Questions: Income Information:
Primary Joint   (Includes alimony, child support, or separate maintenance income. Need not be revealed if applicant does not wish to have it considered as a basis for repaying this obligation.)


Yes


No


Yes


No
Are there any outstanding judgments against you? Applicant's Monthly Income: $

Yes

No

Yes

No
Have you ever been declared bankrupt? Other (Describe): $

Yes

No

Yes

No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Joint Applicant's Monthly Income (if applicable): $
Yes
No

Yes

No
Is any part of the down payment borrowed? Other (Describe): $
Yes
No

Yes

No
Have you ever been denied credit with this bank? Total Monthly Income: $
Insurance Information
Agent / Agency: Address: Phone:  
 

Assets Owned
Description of Assets
Checking Accounts
Where? Acct #: Name: Subject to Debt? Value:
Yes No
Savings/Certificates of Deposit Accounts
Where? Acct #: Name: Subject to Debt? Value:
Yes No
Real Estate
Location: Date Aquired: Name: Subject to Debt? Value:

Yes No
Automobiles
Make/Model: Year: Name: Subject to Debt? Value:

Yes No

Yes No
Total Assets 
Outstanding Debts (include charge accounts, installment contracts, credit cards, rent, mortgages, etc)
Creditor:
Type of Debt or Account Number:
Name In Which The Account Is Carried:
Original Debt:
Present Balance:
Monthly Payment:
Past Due? Y/N
Total Debts:
AFFILIATED BUSINESS ARRANGEMENT DISCLOSURE STATEMENT


****REAL ESTATE TRANSACTIONS ONLY****

This is to give you notice that Drummond Community Bank has a business relationship with the settlement services provider(s) listed below.

Drummond Community Bank has the following business relationship(s) with:

BANKERS TITLE OF THE NATURE COAST, INC.: DRUMMOND COMMUNITY BANK OWNS 100% OF BANKERS TITLE OF THE NATURE COAST, INC.

NATURE COAST INSURANCE, INC.: DRUMMOND COMMUNITY BANK OWNS NATURE COAST INSURANCE, INC.

Because of this relationship, a referral may provide Drummond Community Bank a financial or other benefit.

Set forth below is the estimated charge or range of charges for the settlement service listed. You are NOT required to use the listed provider(s) as a condition for settlement of your loan on the subject property or the purchase, sale or refinance of the subject property. THERE ARE FREQUENTLY OTHER SETTLEMENT SERVICE PROVIDERS AVAILABLE WITH SIMILAR SERVICES. YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT YOU ARE RECEIVING THE BEST SERVICES AND THE BEST RATE FOR THESE SERVICES.

 

Provider and Settlement Service: Charge or Range of Charges:
BANKERS TITLE OF THE NATURE COAST, INC. ~ TITLE INSURANCE $100 - $3,000
NATURE COAST INSURANCE, INC., INSURANCE AGENCY $800 - $1,500

 

ACKNOWLEDGEMENT

I/We have read this disclosure, and understand that Drummond Community Bank may refer me/us to purchase the above-described settlement service, and may receive a financial or other benefit as a result of this referral.

APPLICANTS SIGNATURE(S) APPLICANT CO-APPLICANT DATE
APPLICANTS SIGNATURE(S) APPLICANT CO-APPLICANT DATE
 

Insurance Disclosure For Credit Application


IMPORTANT

DO NOT SIGN THIS FORM UNTIL YOU CAREFULLY READ IT AND UNDERSTAND ITS CONTENT

You have submitted an application for a loan. In connection with your loan application, Lender may be Purpose: soliciting, offering to sell, or will sell you an insurance product or annuity. Federal law requires Lender to provide you with the following disclosures.

Credit Disclosures:

  1. Lender, as a condition of granting you a loan, cannot require that you purchase an insurance product or annuity from Lender or any of its affiliates.
  2. Lender, as a condition of granting you a loan, cannot require your agreement not to obtain or prohibit you from obtaining an insurance product or annuity from an unaffiliated entity.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, RECEIVED AND UNDERSTAND THIS INSURANCE DISCLOSURE.

APPLICANTS SIGNATURE(S) APPLICANT CO-APPLICANT DATE
Signatures

I hereby apply for the loan or credit described in this application. I certify that I made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I did not omit any important information. I agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my account. I understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my application, credit or loan.

APPLICANTS SIGNATURE(S) APPLICANT CO-APPLICANT DATE
NOTICE - JOINT CREDIT: We intend to apply for joint credit. (initials)