myPCB - Consumer Loan Application

Which loan officer are you working with?
Please select a loan officer from the drop-down list above.
Loan Officer Email Address
Consumer Loan Application

Loan Details
Loan Purpose
Use of Loan Funds Explanation
Please give a brief explanation of what the loan funds will be used for. If for debt consolidation, please list the debts to be paid off.
Collateral Type

Other
Vehicle Information (don't forget to click "Save" button)
Recreational Vehicle / Camper Information (don't forget to click "Save" button)
Titled Trailer Information (don't forget to click "Save" button)
Boat Information (don't forget to click "Save" button)
Boat Motor Information (don't forget to click "Save" button)
Boat Trailer Information (don't forget to click "Save" button)
Other Collateral Information
Purchase Price
Down Payment
Loan Amount
Loan Term Requested
Months

Consumer Loan Application

Applicant's Personal Information
Applicant's Name

First NameMiddle NameLast NameSuffix
Applicant's Social Security Number
Applicant's Date of Birth

MonthDayYear
Applicant's E-mail Address
Applicant's Phone Number
Please include area code.Format: (000) 000-0000.
Applicant's Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Applicant has lived at {applicantsPhysical} for years* year(s) and months* month(s).
Applicant * {applicantsPhysical} and the monthly mortgage payment or rent payment is monthly payment*.
Please Note: If the applicant is living rent free or owns it free and clear, enter a zero in the payment amount above.
Applicant's Residential Length
Applicant's Previous Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Applicant lived at {applicantsPhysical322} for year year(s) and months month(s).
Applicant's Mailing Address
Applicant's Mailing Address

Mailing Address

Street Address Line 2

CityState

Zip Code

Consumer Loan Application

Co-Applicant Personal Information
We intend to apply for joint credit.
Co-Applicant's Name

First NameMiddle NameLast NameSuffix
Co-Applicant's Social Security Number
Co-Applicant's Date of Birth

MonthDayYear
Co-Applicant's Email Address
example@example.com
Co-Applicant's Phone Number
Please include area code.Format: (000) 000-0000.
Does Co-Applicant have the same address history as Applicant?
Co-Applicant's Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Co-Applicant has lived at {coapplicantsPhysical} for year year(s) and months month(s).
Co-Applicant {coapplicantsPhysical} and the monthly mortgage payment or rent payment is monthly payment.
Please Note: If the co-applicant is living rent free or owns it free and clear, enter a zero in the payment amount above.
Co-Applicant's Residential Length
Co-Applicant's Previous Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Co-Applicant lived at {applicantsPrevious} for year year(s) and months month(s).
Is Co-Applicant's physical address also their mailing address?
Co-Applicant's Mailing Address

Mailing Address

Street Address Line 2

CityState

Zip Code

Joint Coverage Credit Life Insurance

Now your loan can be paid off in the event of the co-applicant's death. We are pleased to offer this service that protects you and your family.
Are you interested in joint coverage credit life insurance?
What is Co-Applicant's height?
What is co-Applicant's weight?
In what country was Co-Applicant born?
Select country of birth.
In what U.S. State was Co-Applicant born?
Select state of birth.
1. Is Co-Applicant now disabled or contemplating an operation?
2. During the past two years has Co-Applicant been treated for or advised by a licensed physician that Co-Applicant had any of the following: disease of the heart, blood, lungs, liver, pancreas or kidneys; any mental, nervous, circulatory, or digestive disorder; uncontrolled high blood pressure; cancer or tumor; diabetes; stroke; rheumatoid arthritis; drug or alcohol abuse; AIDS, ARC (AIDS Related Complex), or tested positive on an AIDS related blood test?
3. Please list any conditions Co-Applicant may have, if any, that were not previously listed.

Optional: Personal References
Patriot Act Notice:

Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account, including the their name, address, date of birth and other information that will allow us to verify their identity.
Privacy Policy:

Phelps County Bank values our customers and their privacy. To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards, secured files and more.

You can view the privacy policy by clicking the link at the bottom of this webpage.
Switch Submission ID
BorrMailAdd1
BorrMailAdd2
CoBorrMailAdd1
CoBorrMailAdd2
Should be Empty:

Rows	Yes	No	Explain
1. Are there any outstanding judgments against Applicant?
2. Has Applicant ever been declared bankrupt?
3. Has Applicant had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
4. Is Applicant a party to a lawsuit?
5. Is Applicant obligated on any loan resulting in judgment, foreclosure or title transfer?
6. Is Applicant delinquent, in default on any Federal debt, financial obligation, bond, or loan guarantee?
7. Is Applicant obligated to pay alimony, child support or separate maintenance?
8. Is any part of the down payment borrowed?
9. Is Applicant a co-maker or an endorser on a loan?
10. Has Applicant ever had merchandise repossessed?
11. Has Applicant ever been denied credit with us?
12. Is Applicant a U.S. citizen?
12a. Is Applicant a resident alien?

Rows	Yes	No	Explain
1. Are there any outstanding judgments against Co-Applicant?
2. Has Co-Applicant ever been declared bankrupt?
3. Has Co-Applicant had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
4. Is Co-Applicant a party to a lawsuit?
5. Is Co-Applicant obligated on any loan resulting in judgment, foreclosure or title transfer?
6. Is Co-Applicant delinquent, in default on any Federal debt, financial obligation, bond, or loan guarantee?
7. Is Co-Applicant obligated to pay alimony, child support or separate maintenance?
8. Is Co-Applicant a co-maker or an endorser on a loan?
9. Has Co-Applicant ever had merchandise repossessed?
10. Has Co-Applicant ever been denied credit with us?
11. Is Co-Applicant a U.S. citizen?
11a. Is Co-Applicant a resident alien?

Consumer Loan Application