Loan Application

About You

Personal Information

Individual or Joint Individual Credit Joint Credit

Type of Loan Secured Unsecured

Amount Requested:

Term of Loan (in months):

Payment Date Desired:

Proceeds of Loan to Be Used For:

Referred By:

First Name

Last Name

Date of Birth

Email Address

Phone Number

Contact Information

Choose the location you would like to complete your application

How would you prefer to be contacted? Phone Mail Email

When is the best time to arrange an appointment? Morning Lunchtime Afternoon

Current Address

Home Address Line 1

Home Address Line 2

City

State

ZIP

Previous Address

Previous Address Line 1

Previous Address Line 2

City

State

ZIP

Years at home address

Do you own or rent?

Dependent and Relative Information:

Number of Dependents

Age of Dependents

Name of Nearest Relative (Not living with you)

Relationship of Relative

Relative Address Line 1

Relative Address Line 2

City

State

ZIP

Relative Phone Number

Employment Information

Current Employer

Employer's Name

Employer's Phone

Employer's Address Line 1

Employer's Address Line 2

City

State

ZIP

Your Position

Start Date

Gross Salary Per Month

Net Salary Per Month

Previous Employer

Previous Employer's Name

Previous Employer 's Phone

Previous Employer Address Line 1

Previous Employer Address Line 2

City

State

ZIP

Years at previous company

Other Income Sources

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 income received under: None Court Order Written Oral Understanding

Social Security

Pension

Sources of Other Income

Amount Per Month

Is any income listed in this Section likely to be reduced before the credit request is paid off? Yes No

Have you previously received credit from us? Yes No

Marital Status

Complete only if: for joint or secured credit, or applicant resides in a community property state, or is relying on property located in such a state as a basis for repayment of the credit requested.

Applicant Marital Status Married Separated Unmarried Not Applicable

Co-Applicant Marital Status Married Separated Unmarried Not Applicable

Applicant Asset & Debt Information

Checking Account

Checking Bank Name

Checking Address Line 1

Checking Address Line 2

City

State

ZIP

Name in Which the Account is Carried

Savings Account

Savings Bank Name

Savings Address Line 1

Savings Address Line 2

City

State

ZIP

Savings Balance

Name In Which the Account Is Carried

Certificate of Deposit

CD Bank Name

CD Address Line 1

CD Address Line 2

City

State

ZIP

CD Value

Name In Which the Account Is Carried

Marketable Securities Assets

Issuer

Type

Number of Shares

Marketable Securities Value

Name In Which the Asset Is Carried

Real Estate Assets

Real Estate Address Line 1

Real Estate Address Line 2

City

State

ZIP

Date Acquired

Name In Which the Asset Is Carried

Life Insurance Assets

Issuer

Life Insurance Face Value

Name In Which the Asset Is Carried

Automobile Assets

Vehicle Asset Make

Vehicle Asset Model

Vehicle Asset Year

Vehicle Asset Value

Name In Which the Asset Is Carried

Other Assets

Description of Other Assets

Value

Name In Which the Asset Is Carried

Home Debt

Rent or Mortgage Payment Rent Mortgage

Landlord or Mortgage Holder

Original Amount

Present Balance

Monthly Payment

Name In Which the Lease or Mortgage Is Carried

Automobile Debt

Automobile Debt Creditor

Vehicle Make

Vehicle Model

Vehicle Year

Original Amount

Present Balance

Monthly Payment

Name In Which the Loan Is Carried

Other Debt

Other Debt Creditor

Original Amount

Present Balance

Monthly Payment

Name In Which the Debt Is Carried

Secured Credit

If requesting Secured, please fill out the fields below. If requesting Unsecured, skip to the submission button.

Secured Credit: Property Description

Co-Owner Name

Co-Owner Address Line 1

Co-Owner Address Line 2

City

State

ZIP

If the security is real estate, give the full name of your spouse (if any)

Disclosures

Important Information About Our Insurance Sales Practices

Please read this notice carefully and keep a copy for your records. Our bank will not condition the approval of your loan application on your purchase of any type of insurance product from this bank or any of its affiliates.

If you choose to purchase an insurance product you may do so from any insurance agency or broker.

Our bank offers credit life and accident health insurance through American National Insurance Company, however you are not required to purchase this or any type of insurance in order to obtain a loan from us.

American National Insurance is:

NOT A DEPOSIT ACCOUNT OR OTHER OBLIGATION of any depository institution or any affiliate of any depository institution.
NOT GUARANTEED OR INSURED by any depository institution or any affiliate of and depository institution.
NOT INSURED by the Federal Deposit Insurance Corporation (FDIC).
Except in the case of Federal Flood Insurance or Federal Crop Insurance, is NOT INSURED by any federal government agency.

Acknowledgement of Disclosure By checking this box, I acknowledge that I have read this disclosure and understand its contents. I/we understand that this acknowledgement is part of the loan application.

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

Open an Account

Personal Information

Contact Information

Current Address

Previous Address

Dependent and Relative Information:

Current Employer

Previous Employer

Other Income Sources

Checking Account

Savings Account

Certificate of Deposit

Marketable Securities Assets

Real Estate Assets

Life Insurance Assets

Automobile Assets

Other Assets

Home Debt

Automobile Debt

Other Debt

Important Information About Our Insurance Sales Practices