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*

PurchaseRefinancePersonal (Unsecured)
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

VehicleRecreational Vehicle / CamperTitled TrailerBoat, Motor & TrailerMulti-CollateralOther
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.
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*

Same as Current Physical AddressDifferent Mailing Address
Applicant's Mailing Address

Mailing Address

Street Address Line 2

CityState

Zip Code

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
Should be Empty:

	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?

Consumer Loan Application