Applications - Personal or Home Equity Loan, or Line of Credit

Please provide the following contact information:
* = Required Fields

*Dollar Amount Requested

$

*Type of Loan: Personal Loan orHome Equity Loan or
Home Equity Line of Credit

Please tell us about yourself:

*First Name of Applicant

*Last Name of Applicant

Middle Initial

*Current Street Address

Address (cont.)

*City

*State

Zip/Postal Code

County

*Years/months at current residence

*Home Phone

*Social Security Number:

*Date of Birth:

(mm/dd/yyyy)

*Driver's License No.

*No. Dependents

*Ages of Dependents


Previous Street Address:

Address (cont.)

City

State

Zip/Postal Code

Years/months

Tell us About Your Employment:

Employer Name

Years/Months

Self Employed

Business Address Number
and Street

City

State

Zip/Postal Code

Business Phone

Position

Personal Monthly Employment Income

$

Previous Employer

Years/Months


Other Income

You do not disclose alimony, child support or separate maintenance income
unless you want us to consider it for purposes of this application.

Annual Interest & Dividend Income

$

Monthly Child Support or separate maintenance

$

Other Monthly Household Income

$

Please describe the sources of Other Household Income


If you have a Co-Applicant, fill out this section, if not,

CONTINUE.....

Personal Information (Co-Applicant)

First Name of Co-Applicant

Last Name of Co-Applicant

Middle Initial

Current Street Address

Address (cont.)

City

State

Zip/Postal Code

County

Years/months at current residence

Home Phone

Social Security Number:

Date of Birth:

(mm/dd/yyyy)

Driver's License No.

No. Dependents

Ages of Dependents

Employment Information (Co-Applicant)

Co-Applicant Employer Name

Years/Months

Self Employed

Business Address Number and Street

City

State

Zip/Postal Code

Business Phone

Position

Personal Monthly Employment Income

$

Co-Applicant's Previous Employer

Years/Months


Marital Status -

Do not complete marital status if this is an application for Individual unsecured credit.

Applicant 

Co-Applicant

Nearest Living Relative -

Name of nearest relative not living with you  

Street Address

City

State

Zip/Postal Code

Phone No.

Relationship

About Your Existing Loans and Accounts

Rent or Own Home

Monthly Rent or Payment

$

Purchase Price

$

Original Loan Amount

$

Balance Owing

$

Present Value

$

Date Purchased

Name of Mortgage Holder or Landlord

Name of My Bank

Checking Account #

Savings Account #

Monthly child support or separate maintenance payment

$


Have you ever had a judgment filed against you or declared bankruptcy?


Other Financial Information

ASSETS

Assets

Value

Cash in Banks

$

Stocks or Bonds

$

Automobiles

$

Real Estate

$

Life Insurance (Face Value)

$

Retirement Funds, IRA's

$

Other Assets

$

Other Assets

$

OBLIGATIONS

Description

Amount Owed

Monthly Payment

Unsecured Bank Loans

$

$

Secured Bank Loans

$

$

Auto Loans

$

$

Total Real Estate Obligations

$

$

Life Insurance Loans

$

$

Credit Card Debt

$

$

Other Obligations

$

$

Other Obligations

$

$

Other Obligations

$

$

Please read the terms below..... Click on Submit at the end of the documents to complete the application.  By submitting this application, all terms are accepted by the customer.  

I/We represent that this application is complete and accurate and fully reflects my/our financial condition on the date shown below.  I/We agree to notify Lender immediately, in writing, of any adverse change in my/our financial condition.  I/we understand that Lender will retain this Application whether or not it is approved.


INFORMATION DISCLOSURE AUTHORIZATION

To Whom it May Concern:

I/We hereby authorize you to release to BNC National Bank its successors and/or assigns, for verification purposes, information concerning:

[ X ] Employment history, dates, title, income, hours worked, etc…

[ X ] Checking, savings, and investment accounts (including copies of statements, etc.).

[ X ] Mortgage/Consumer/Business loan rating, (opening date, high credit, payment amount, loan balance, and payment record).

[ X ] Personal and business records from accountants, attorneys, etc… that may have information required for the processing of a loan.

[ X ] Any information deemed necessary in connection with a credit report for a mortgage/consumer/business loan transaction.

The information is for the confidential use of the lender in determining my/our creditworthiness for a mortgage/consumer/business purpose loan.

A PHOTOGRAPHIC COPY of the under sign's authorization MAY BE DEEMED TO BE THE EQUIVALENT OF THE ORIGINAL and MAY BE USED AS A DUPLICATE ORIGINAL.  The original signed form is maintained in the BNC NATIONAL BANK, 322 EAST MAIN, BISMARCK, ND 58501 OFFICE.

Your prompt reply will help my/our loan transaction.


Important Information

Procedures for opening a New Account
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

What this means for you:
When you open an account, we will ask you for your name, address, date of birth, and other information that will allow us to identify you.  We may also ask to see your driver's license or other identifying documents.

Credit Disclosure Statement
Borrowers of BNC National Bank are not required to obtain insurance from a particular insurance company. Any insurance required as a condition of the extension of credit by BNC National Bank may, without affecting approval of the application for an extension of credit, be purchased from an insurance company of the Borrower's choice.



PRIVACY STATEMENT
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Revised: 08/15/2011

Want more information? It's Easy!

Apply online, visit a local branch, fill out a contact us form and a banking representative will contact you, or call us at 1-800-BNC-BANK (1-800-262-2265).

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Application Center

Select from the list below to open the account of your choice today!

How Can We Help You?

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