Personal Loan Application

Important Application Information: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and asked to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. Our privacy policy and federal law protect the information you provide.

Must be 18 years old to apply for an account.

Are you an existing Manhattan Bank Customer? *

Yes

No

Individual or Joint:

Individual

Joint

Credit Requested

Amount Requested *

For How Long *

Preferred Payment Day *

Collateral Offered/Description *

Purpose *

Primary Applicant Information

First Name *

Middle Name *

Last Name *

Other Names in Which Credit Has Been Granted

Social Security Number *

Date Of Birth *

Driver's License Number *

Driver's License Issue Date *

Driver's License Expiration Date *

Driver's License State of Issuance *

Number of Dependents

Name & Address of Nearest Relative Not Living With You

Relationship

Phone

Current Physical Address *

Years/Months *

City *

State *

Zip Code *

Do you Rent or Own?

Rent

Own

Mailing Address *

City *

State *

Zip Code *

Previous Address (if current less than 2 years)

Years/Months

City

State

Zip Code

Email Address *

Home Phone *

Cell Phone *

Employment Information

Employer (Company Name & Address)

Occupation

Work Phone

No. of Years

Monthly Salary $

Previous Employer (Company Name & Address)

Occupation

Work Phone

No. of Years

Monthly Salary $

Note: Alimony, child support, or separate maintenance income need not 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

Sources of Other Income

Amount Per Month

Bank Name & Address

Checking Account No.

Current Balance

Bank Name & Address

Savings Account No.

Current Balance

Co-Applicant Information

First Name *

Middle Name *

Last Name *

Other Names in Which Credit Has Been Granted

Social Security Number *

Date Of Birth *

Driver's License Number *

Driver's License Issue Date *

Driver's License Expiration Date *

Driver's License State of Issuance *

Number of Dependents

Name & Address of Nearest Relative Not Living With You

Relationship

Phone

Current Physical Address *

Years/Months *

City *

State *

Zip Code *

Do you Rent or Own?

Rent

Own

Mailing Address *

City *

State *

Zip Code *

Previous Address (if current less than 2 years)

Years/Months

City

State

Zip Code

Email Address *

Home Phone *

Cell Phone *

Co-Applicant Employment Information

Employer (Company Name & Address)

Occupation

Work Phone

No. of Years

Monthly Salary $

Previous Employer (Company Name & Address)

Occupation

Work Phone

No. of Years

Monthly Salary $

Note: Alimony, child support, or separate maintenance income need not 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

Sources of Other Income

Amount Per Month

Bank Name & Address

Checking Account No.

Current Balance

Bank Name & Address

Savings Account No.

Current Balance

Asset & Debit Information

I/We Own

Cash on Hand and in Bank

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Stocks and Bonds

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Auto

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Year

Make

Model

Auto

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Year

Make

Model

Home-Present Value

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Other Real Estate

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Personal Property

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

List Other Assets

Other Asset Description

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Other Asset Description

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Other Asset Description

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Other Asset Description

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Total Assets

I/We Owe

Auto Loan

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Monthly Payment

Value

Other Bank Loans

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Monthly Payment

Value

Home Loan

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Monthly Payment

Value

Rent

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Monthly Payment

Value

List Other Debts

Installment Loan Account

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Installment Loan Account

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Installment Loan Account

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Installment Loan Account

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Installment Loan Account

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Installment Loan Account

Owned by

Applicant Only

Joint and Co-Applicant

Co-Applicant Only

Applicant & Another Party

Value

Total Monthly Payments

Total Liabilities

Net Worth (Total Assets minus Liabilities)

Total Liabilities & Net Worth

Applicant Statement

I hereby declare that the above credit representation is true, accurate, and complete to the best of my knowledge and belief, and are submitted for the purposes of receiving credit. I certify that I have attained the age of majority and have the capacity to enter into a binding contract. I hereby authorize Manhattan Bank to check my credit and employment history. This authorization is given to enable Manhattan Bank to promptly and fairly evaluate my request for credit.

Asset & Debit Information

Applicant Statement

Thank you for your submission!