Happy State Bank is verified by Verisign, Inc.
Wednesday, February 10, 2016
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.
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.
Mike Amos - Borger
Annette Anders - Abillene
Stacy Armstrong - Amarillo Soncy
Travis Atwood - DFW North Tollway
Trish Baker - Higgins
Ronda Bartlett - Canadian
Steve Bowen - Amarillo Taylor
Alvia Calvert - Dumas
Holly Cardenas - Amarillo Taylor
Cade Carpenter - DFW North Tollway
Teresa Chastain - Dumas
Lisa Clawson - DFW North Tollway
Rusty Conway - Amarillo Taylor
Doak Crabtree - Stratford
Lanny Crow - Sunray
Jennifer Currie - Amarillo Tascosa
Debbie Davis - Amarillo Coulter
J Alan Eubank - Pampa
Courtney Evans - Amarillo Bell
Ryan Evans - Amarillo Taylor
Brent Falkenberg - Plainview
Valerie de la Fuente - Amarillo Georgia
Kyle Fuston - Silverton
Ernie Gandy - Olton
Salvador Gonzalez - Dalhart
Robert Gottlich - DFW North Tollway
Erica Guzman - Pampa
Mark Hanbury - Canadian
Brandon Harrison - Plainview
Bud Holmes - Lubbock 19th
Jay House - Lubbock 19th
David Hutson - Canyon
Jeff Irwin - Amarillo Taylor
Mike Jackson - Lubbock 19th
Chris Jameson - DFW North Tollway
Scott Jones - Abilene
Shelly Kearns - Amarillo Taylor
Trisha Keener - Stratford
Lisa Kirkwood - Amarillo Teckla
Gayle Koehn - Texline
Sara Lackey - Lubbock 19th
Bill Latimer - Amarillo Express
Scott Lewis - DFW Watters Creek
Scotty Lindley Abilene
Kelly Livingston - Shamrock
Hunter Lord - DFW Watters Creek
Debbie Loyless - Amarillo Western
Scott Martin - Amarillo Soncy
Kim Mauldin - Canadian
Ken Maynard - DFW North Tollway
Marianne McCoy - Amarillo Taylor
Willis McCutcheon - Plainview
Janet McKeehan - Abilene
Larry MCLean - DFW North Tollway
Dianne Monroe - Amarillo Taylor
Mike Monroe - DFW North Tollway
Ryan Monroe - Amarillo Taylor
JD Morrison - Amarillo Taylor
Marco Navarro - DFW North Tollway
Leslie Otwell - Amarillo Soncy
Geoff Phemister - Amarillo Soncy
Jason Reep - Amarillo Taylor
Steve Rodriquez - Abilene
Anthony Sandoval - Abilene
Steve Seabourn - Amarillo Soncy
Brady Shadid - Panhandle
Judy Shipman - Happy
Mike Sluder - Canyon
Peter Smith - Lubbock 19th
Crysta Stallwitz - Dumas
Nancy Stuckey - Plainview
Matthew Tavern - Amarillo Taylor
Monty Teeter - Lockney
Jessica Terrell - Lubbock 19th
Chrisy Thomason - Canyon
Ryan Vance - DFW North Tollway
Alan VanOngevalle - Amarillo Taylor
Erin Viermann - Amarillo Taylor
Shane Watson - Amarillo Taylor
Trey Weaver - Lubbock 19th
Dale Welch - Dumas
Gary Wells - Amarillo Taylor
Kay West - Pampa
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 © 2016 Happy State Bank and Trust Company. All rights reserved.