First Bank of Newton
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Personal Credit Application

First Bank of Newton is located solely within the state of Kansas, county of Harvey, USA. Our trade area includes Harvey county and under certain circumstances neighboring counties including Sedgwick, Reno, Butler, McPherson and Marion. Applications outside our trade area will not be accepted through the Internet.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, physical adress, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.

Please read following directions before completing this application, and choose the appropriate circle.
Check here if you are applying for individual credit. This means you are applying in your own name and are relying on your own income or assets, NOT those of another person as the basis for repayment.


Complete only the applicant information.
Check here if you are applying for joint credit. This means you are applying for credit with another person and will be relying on both your and their income or assets as the basis for repayment.

We intend to apply for joint credit.

Applicant:  (please initial)
Co-Applicant:  (please initial)
(Required if Joint Credit selected)

Complete both the applicant information and,
the co-applicant information.
* Required Fields
Personal Credit Application
* $
*
If Purpose of Loan involves a vehicle, please provide the Year,
Applicant Information
Yes No
*
*
* / /
(mm/dd/yyyy)
* ( )   -
Address Information
*
(If Military, APO, or FPO Address or if N/A, Next of Kin or Friend.)
* / /
/ /
/ /
If United States Person: (Complete all that apply)
(if not proceed to next section)
- -    or   
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Non United States Person: (Complete all that apply)
- -    or   
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Additional Applicant Information
   
   
* Married Separated Unmarried (single, divorced, widowed)
/ /
( )   -
Applicant Employment Information
*
/ /
  Ext.  
* $   per  
$   per  
/ /
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.
Court Order Written Agreement Oral Understanding
$     Weekly Monthly Yearly
No Yes     If Yes, Explain:
Co-Applicant Information
/ /
(mm/dd/yyyy)
( )   -
Address Information

(If Military, APO, or FPO Address or if N/A, Next of Kin or Friend.)
/ /
/ /
/ /
How Long at Previous Address?:
If United States Person: (Complete all that apply)
(if not proceed to next section)
- -    or   
- -
(mm/dd/yyyy)
- -
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Non United States Person: (Complete all that apply)
- -    or   
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Additional Applicant Information
   
   
Married Separated Unmarried (single, divorced, widowed)
/ /
( )   -
Co-Applicant Employment Information
/ /
  Ext.  
How long with present employer?
$   per  
$   per  
How Long with Previous Employer:
/ /
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.
Court Order Written Agreement Oral Understanding
$     Weekly Monthly Yearly
No Yes     If Yes, Explain:
List All Assets Owned
Note: Please provide the following information for both the Applicant and the Co-Applicant:
Cash
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Cash Value of Life Insurance (Issuer, Face Value)
$
Yes No
Real Estate (Location, Date Acquired)
$
Yes No
Marketable Securities (Issuer, Type, No. of Shares)
$
Yes No
Other (List)
$
Yes No
$
  
Co-Applicant
Cash
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Cash Value of Life Insurance (Issuer, Face Value)
$
Yes No
Real Estate (Location, Date Acquired)
$
Yes No
Marketable Securities (Issuer, Type, No. of Shares)
$
Yes No
Other (List)
$
Yes No
$
  
Outstanding Debts
Note: Include charge accounts, installment contracts, credit cards, rent, mortgages, etc.
Landlord or Mortgage Holder
Rent
Mortgage
(Omit Rent)
(Omit Rent)
(Rent)
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Total Debts:  
$
 
Credit References
(Paid off Accounts)
Type of Debt
or Account #
Name in Which
Account is Carried
Original
Debt $
Date
Paid Off

*
Yes
No
If "Yes", For Whom:
To Whom:
*
Yes
No
If "Yes", To Whom Owed:
Amount:
$
*
Yes
No
If "Yes", Where:
What Year:
Applicant Insurance Information
Please complete the following section if securing this loan with a vehicle or property.
( )   -
Secured Credit
Note: Complete only if credit is to be secured.
Briefly describe the property to be given as security:
Name 1:  
Address:
Name 2:  
Address:
Name 3:  
Address:
 
 
By completing this loan application, you certify that the information in it and on any attachments is correct and you authorize First Bank of Newton to verify such information, to obtain credit reports, to verify any other credit references, and to make such other investigation as First Bank of Newton deems appropriate. UPDATED FINANCIAL INFORMATION: First Bank of Newton may request from reporting agencies from time to time credit reports on you and request new financial information directly from you or others for the purpose of updating First Bank of Newton records. You agree to promptly provide such financial information to First Bank of Newton. First Bank of Newton may rely on such information to make credit decisions concerning your loan. You agree to notify First Bank of Newton of any adverse change in your financial condition.
 

FEDERAL CONSUMER CREDIT DISCLOSURES

CREDIT DISCLOSURES: An Insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity: (1) The Insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliate(s); (2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, this institution, or our affiliate(s); and (3) In the case of an insurance product or annuity that involves an investment risk, there is investment risk associated with the insurance product, including the possible loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following: (1) Your purchase of an insurance product or annuity from us or any of our affiliates; or, (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.

 
Applicant Signature:*
 
Co- Applicant Signature:
(where applicable)
 
 
*GOVERNMENT MONITORING DATA: IF THE PURPOSE OF THIS LOAN IS FOR HOME IMPROVEMENT, HOME PURCHASE, OR REFINANCE, PLEASE READ AND COMPLETE THE FOLLOWING:
 
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both the ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
 
    I do not wish to furnish the following information
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Native Hawaiian or Pacific Islander
Black or African American
Asian
White
Male
Female
 
    I do not wish to furnish the following information
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Native Hawaiian or Pacific Islander
Black or African American
Asian
White
Male
Female





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MEMBER FDIC

FIRST BANK
4 Locations in Newton & Hesston to Serve You
316-283-2600

equal housing lender
PRIVACY POLICY | SECURITY | AGREEMENTS & DISCLOSURES
©2012 First Bank of Newton, all rights reserved. Please see our Internet User Agreement. First Bank of Newton is the full legal name of First Bank, located in Newton and Hesston, Kansas.

Harvey County's Oldest Bank... Established 1873