Consumer Loan Application Attention: Print out the form , then fill it. Sign the bottom of the form and then either fax the form to our Loan Department at 580-477-4211 or mail it to us at: 721 N Main St, Altus, OK 73521 580-482-6100 Back to Loan Services Amount of Loan Requested   Purpose of Loan Select Loan Type Auto Second Mortgage Loan Term Requested   Months Years Application Information Marital Status: Married Single Divorce Separated Widowed   First Name   Last Name   E-mail Address   Street Address   City, State ,   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY Zip-Plus 4 - Social Security #   Home Phone   - Residence Own Rent          How Long? Months Years Mortgage \ Rent Payment    (monthly) Employer   Occupation   Salary       Per  Year Month Weekly Bi-monthly Work Phone   - Length of Employment   years       months Check yes if you have a MasterCard, VISA or Discover Card? yes Current Financial Institution     Checking          Savings           Loan    Account Number   Other Income (per month)   Source(s) of other Income Co-application Information Marital Status: Married Single Divorce Separated   First Name Last Name e-mail Address Street Address City, State ,   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY Zip-Plus 4 - Social Security # Home Phone   - Residence Own Rent          How Long? Months Years Mortgage \ Rent Payment    (monthly) Employer Occupation   Salary       Per  Year Month Weekly Bi-monthly Work Phone   - Length of Employment   years       months Check yes if  you have a MasterCard, VISA or Discover Card? yes Current Financial Institution Checking          Savings           Loan    Account Number   Other Income (per month)   Source(s) of other Income   Are you an endorser, guarantor or co-maker for others?    yes     no If yes, please list creditor's name, borrower's name and account number. Any judgment, bankruptcy, garnishment, legal proceedings against you? If yes, list type of proceeding and date.    yes     no Use the box below to list any additional information or requests I acknowledge that I have made this application with the intent that First State Bank of Altus should rely upon the information contained herein in granting the credit requested. I understand that, if the requested information is granted, First State Bank of Altus may report information concerning the credit to consumer reporting agencies and to others. I affirm that my answers are complete and true and authorize First State Bank of Altus to verify or obtain any information concerning them. Upon First State Bank of Altus's request, I further authorize any firm or individual from whom I may have obtained or requested credit, to furnish the details of that transaction. I also agree to provide current financial information upon request, in a form that is acceptable. Signature :