The Farmers Bank of Liberty


OnLine Credit Application!

Being a REAL community bank, The Farmers Bank of Liberty normally restricts its loans to a 10-15 mile radius of our three community banking centers in Liberty, Barry and Payson, Illinois. If you would like to apply for a loan with us, please fill out the following credit information, print it out and sign it, and send it to us at our office which is nearest to you. Our professional loan officers will follow up with you quickly to analyze your loan request. Depending on the type of loan you are requesting, additional information may be requested from you to complete the application process, but this will give us a great place to start. Our goal is to help our loan customers get what they need and then get them out of debt as quickly as possible and turn them into major depositors!! You can do it with our expert help!! If you have any questions regarding this application, please call 1-217-645-3434 and ask for Customer Service, or e-mail us.


Loan Amount requested:

$

Purpose of Loan:

 

INFORMATION REGARDING APPLICANT

Section A - APPLICANT INFORMATION

Section B - CO-APPLICANT (if applicable)

First Name

First Name

MI

MI

Last Name

Last Name

Birthdate:

/ /

Birthdate:

/ /

Social Security Number

Social Security Number

Present Street Address

Present Street Address

City State

City State

Zip

-

Zip

-

Years there

Years there

Telephone #

( ) -

Telephone #

( ) -

Driver's License

Driver's License

Previous Street Address

Previous Street Address

City State

City State

Zip

-

Zip

-

Years there

Years there

Present Employer

Present Employer

Address

Address

City State

City State

Zip

-

Zip

-

Years there

Years there

Telephone

( ) -

Telephone

( ) -

Position or title

Position or title:

Name of supervisor

Name of supervisor

Previous Employer

Previous Employer:

Previous Employer's Address

Previous Employer's Address

City State

City State

Zip

-

Zip

-

Present net salary or commission per month:

$

Present net salary or commission per month:

$

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Alimony, child support, separate maintenance received under:

court order
written agreement
oral understanding.

Alimony, child support, separate maintenance received under:

court order
written agreement
oral understanding.

Other income:

$

Other income:

Other income source:

Other income source:

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

Yes No

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

Yes No

Name of nearest relative not living with you

Name of nearest relative not living with you

Relationship

Relationship

Address

Address

City State

City State

Zip

-

Zip

-

Telephone

( ) -

Telephone

( ) -

 

Checking Account #

Checking Account #

Institution and Branch

Institution and Branch

Savings Account #

Savings Account #

Institution and Branch

Institution and Branch

Please complete if you've received credit with us.

Date of Loan Approval

/ /

Date of Loan Approval

/ /

SECTION C- MARITAL STATUS
(Do not complete if this is an application for individual unsecured Credit.)

Applicant

Married
Separated
Unmarried (including single, divorced, and widowed)

Other Party

Married
Separated
Unmarried (including single, divorced, and widowed)

SECTION D - ASSET AND DEBT INFORMATION

(If Section B has been completed, this Section should be completed giving information about both the Applicant and Joint Applicant or Other Person. Please mark Applicant-related information with an "A." If Section B was not completed, only give information about the Applicant in this Section.)

Assets Owned

Description of Assets

Value

Subject to Debt?

Names(s) of Owner(s)

Cash

$

Yes
No


Automobiles (Make, Model, Year)


$

Yes
No

$

Yes
No

Cash Surrender Value of Life Insurance
Issuer:
Face Value:

$

Yes
No

Real Estate

Location


Date Acquired
/ /

$

Yes
No

Location


Date Acquired
/ /

$

Yes
No

Marketable Securities

Issuer


Type


No. of Shares

$

Yes
No

Issuer


Type


No. of Shares

$

Yes
No

Other

$

Yes
No


Other

$

Yes
No

Total Assets

$

 

 

OUTSTANDING DEBTS
(Include charge accounts, installment contracts, credit cards, rent, mortages, etc.)

Creditor

Type of Debt.or Acct. No.

Original Debt

Present Balance

Monthly payments

Past Due?

(Landlord or Mortgage Holder)

Rent Payment
Mortgage

(Omit Rent)
$

(Omit Rent)
$

$

Yes
No

Credit Cards

$

$

$

Yes
No

Credit Cards

$

$

$

Yes
No

Medical

$

$

$

Yes
No

Other

$

$

$

Yes
No

Total Debts

$

$

$

Yes
No

Additional Credit References

Date Paid

$

$

$

$

$

$

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

Yes for $
No

To whom?

Are there any unsatisfied judgments against you?

Yes $
No

To whom?

Have you been declared bankrupt in the last 14 years?

Yes where?
No

Year

Other obligations - (E.g., liability to pay alimony, child support, separate maintenance.)

 

Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

 
 
 
 

Borrower's Signature

Date

Co-Borrower's Signature

Date

Loans for residential real estate may require a more detailed application. Please call or visit for additional information.

Please enter information, print and send to your nearest location:

The FARMERS BANK of Liberty
1002 North Main
Liberty, IL 62347

FBL-BARRY Community Banking Center
PO Box 132
Barry, IL 62312

Payson Community Banking Center
402 West State Street
Payson, IL 62360

The Farmers Bank of Liberty
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