Credit Application

IMPORTANT: Please read these directions before completing this Application, and check the appropriate box below.

Please initial here:


Applicant

Co-Applicant

Section A - Information Regarding Applicant

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Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have.

Alimony, child support, separate maintenance

Have you ever received credit from us?

Section B - Information Regarding Joint Applicant or Other Party

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Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have.

Alimony, child support, separate maintenance

Is any income listed in this Section likely to be reduced before the credit requested is paid?

Have you ever received credit from us?

Section C - Marital Status (Do not complete if this is an Application for individual unsecured credit).

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Applicant

Other Party

Section D - Asset & Debt Information

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If section B has been completed, this section should be completed giving information about both the Applicant and Joint Applicant or Other Person. If Section B was not completed, only give information about the Applicant in this section.

Assets Owned
Automobiles
+ Add Automobiles
Cash Value of Life Insurance
Real Estate
Marketable Securities
Other
Outstanding Debts (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use separate sheet if necessary).
Creditor
+ Add another outstanding debt
Credit References (Paid off Accounts)

Are you a co-maker, endorser, or guarantor on any loan or contract?


Have you declared bankruptcy in the last 10 years?


Section E - Secured Credit

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If vehicle, please complete

The lender may not condition an extension of credit on either: (1) My purchase of an insurance product or annuity from the lender of any of it's affiliates; or (2) My agreement not to obtain, or a prohibition on me from obtaining, an insurance product of annuity from an unaffiliated entity. Everything that I have stated in this application is corrected to the best of my knowledge. I understand that you will retain this Application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. I further acknowledge that I have received the disclosures described in Section F.

By clicking Submit below, I certify that everything I have stated in this application is correct. Citizens Bank Minnesota may keep this application whether or not it is approved. By submitting this application I authorize Citizens Bank Minnesota to check my credit and employment history and to answer questions others may ask Citizens Bank Minnesota about my credit record with Citizens Bank Minnesota. I understand that I must update credit information at Citizens Bank Minnesota request if my financial condition changes.

THE LENDER MAY NOT CONDITION AN EXTENSION OF CREDIT ON EITHER:
1) My purchase of an insurance product of annuity from the lender of any of its affiliates; or
2) My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity.

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