Happy State Bank is verified by Verisign, Inc.
Wednesday, January 18, 2017
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.
No, my home is not being offered as collateral for this loan request.
Yes, my home is being offered as collateral for this loan request.
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:
Purpose of the Loan:
Purchase / Lease Vehicle
Refinance / Repair Vehicle
Down Payment / Purchase of Non-RE Property
Down Payment of RE Property
Establish / Repair Credit
Purchase RV (Boats, RVs, Motorcycles)
Refinance RV (Boats, RVs, Motorcycles)
Family - Wedding / Medical / Funeral / Legal Expenses / Taxes
Purchase of Household Goods
Vacation / Travel Expense
Please include any information that would be used in determining value, ie - Year, Make, Model and Vin if collateral is a vehicle
How long at this address?
Social Security Number:
Date of Birth:
Driver's License Number:
Issue Date: (if available)
Number of Dependents:
Years at Company:
Do You Have a Checking Account?
If Yes, Account #:
Is This a Happy State Bank Checking Account?
Do You Have a Savings Account?
Is This a Happy State Bank Savings Account?
Would You Like to Auto Debit?
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.
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
Cade Carpenter - DFW Ridgmar
Teresa Chastain - Dumas
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
Valerie de la Fuente - Amarillo Georgia
Kyle Fuston - Silverton
Ernie Gandy - Olton
Robert Gottlich - DFW Ridgmar
Erica Guzman - Pampa
Mark Hanbury - Canadian
Brandon Harrison - Plainview
Cheryl Hohertz - Canadian
Jay House - Lubbock 98th
David Hutson - Canyon
Mike Jackson - Lubbock 98th
Chris Jameson - DFW North Tollway
Scott Jones - Abilene
Shelly Kearns - Amarillo Taylor
Trisha Keener - Stratford
Lisa Kirkwood - Amarillo Teckla
Gayle Koehn - Texline
Bill Latimer - Amarillo Express
Kelly Livingston - Shamrock
Hunter Lord - DFW Watters Creek
Debbie Loyless - Amarillo Western
Christina Lucio – Hereford
Scott Martin - Amarillo Soncy
Kim Mauldin - Canadian
Ken Maynard - DFW North Tollway
Willis McCutcheon - Plainview
Mike Monroe - DFW Ridgmar
Ryan Monroe - Amarillo Taylor
Marco Navarro - DFW North Tollway
Dennis Ortiz - DFW Ridgmar
Leslie Otwell - Amarillo Soncy
Geoff Phemister - Amarillo Soncy
Max Price - DFW Ridgmar
Jason Reep - Amarillo Taylor
Steve Rodriquez - Abilene
Steve Seabourn - Amarillo Soncy
Brady Shadid - Panhandle
Angela Shafer - Amarillo Taylor
Judy Shipman - Happy
Mike Sluder - Canyon
Peter Smith - Lubbock 98th
Nancy Stuckey - Plainview
Matthew Tavern - Amarillo Taylor
Monty Teeter - Lockney
Jessica Terrell - Lubbock 98th
Chrisy Thomason - Canyon
Ryan Vance - Ridgmar
Erin Viermann - Amarillo Taylor
Tamara Vogel - Hereford
Shane Watson - Amarillo Taylor
Trey Weaver - Lubbock 98th
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.
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