Happy State Bank is verified by Verisign, Inc.
Tuesday, December 01, 2015
This consumer loan application is not intended for use with residential real estate mortgages. I/we acknowledge that I/we are not applying for credit which will be secured by our primary residence.
I/we are 18 years of age or older.
I am applying for credit in my own name and am relying solely on my own income and assets for the repayment of the requested loan.
We intend to apply for a joint loan.
UCC Secured (windows, roof, A/C and Heating)
(*Cannot be primary residence)
You are applying for a loan with the bank. The bank offers credit insurance products. Insurance products sold through or in the bank are not insured by the Federal Deposit Insurance Corporation and are not issued, guaranteed, or underwritten by the bank or the Federal Deposit Insurance Corporation or any other Federal Government Agency. You are not required or obligated to purchase insurance from the bank or any subsidiary, affiliate or particular unaffiliated third party as a condition to obtaining your loan, and your decision as to insurance agents will not affect your credit terms in any way. The bank may not condition an extension of credit on your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.
Do not Acknowledge
Amount of Loan Requested:
Payment Date Requested:
Describe Home Improvements Being Made:
How long at this address?
Social Security Number:
Date of Birth:
Drivers License Number:
Issue Date: (if available)
Number of Dependants:
Years at Company:
The following information is requested by the federal government for certain types
of loans related to a dwelling in order to monitor the lender’s compliance with
equal credit opportunity, fair housing and home mortgage disclosure laws. You are
that lender may not discriminate on the basis of this information, or on whether
you choose to furnish it.
I do not wish to furnish this information.
I wish to furnish this information.
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Black or African American
Native Hawaiian or Other Pacific Islander
I do not wish to furnish this information
If you have no income in this section, please put "none" in the box.
Any income derived from alimony, child support, or separate maintenance payments need NOT be included in this application or revealed if you do not desire that such income be considered in determining your creditworthiness.
Interest / Dividend Income:
Describe Other Income (if applicable):
Are you responsible for any other contingent liabilities by court order?
If yes, please describe:
Do you own or rent your residence?
Complete this last section only if you are applying for secure credit, or you reside in a community property state or you are relying on property located in such a state.
J Alan Eubank
Valerie de la Fuente
By clicking on "Submit" I/We represent that this application is complete and accurate and fully reflects my financial condition as of today's date. I authorize Lender to obtain a credit report and any other information it deems necessary about my credit worthiness. I agree to notify Lender immediately, in writing, of any adverse change in my financial condition. I understand that Lender will retain this application whether or not it is approved.
Copyright © 2015 Happy State Bank and Trust Company. All rights reserved.