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Rolling Hills Bank & Trust
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Consumer Loans

Rolling Hills Bank & Trust offers various types of consumer loans including auto loans, personal loans, consolidation loans etc., all at competitive interest rates.

This application should be used for any consumer loan request other than for the purchase or refinance of a 1 to 4 family residence. 

Fields marked with * are required.
I / WE ARE APPLYING FOR CREDIT ON *
Applicant Information
Time At This Address
Own Or Rent
Amount of time at Former Address
Marital Status
Present Employer - Time At
Income Information

Alimony, child support or separate maintenance need not be disclosed unless you wish it to be considered as a basis for repaying this obligation.

Alimony child support or separate maintenance received under
Other Income
Is any of this income likely to be reduced before the credit request is paid off?
Have you ever declared bankruptcy in the past 10 years?
If YES to bankruptcy
Are there any unsatisfied judgements against you?
If YES to unsatisfied judgements
Are you a Co-Maker, endorser or guarantor on any loan or contract?
If YES - to being a Co-Maker
Have you had any bad credit over the past 7 years?
If YES to bad credit
Do you have any contingent liabilities such as pending lawsuits or leases?
If YES to contingent liabilities
Co-Applicant Information
Co-Applicant - Time At Address
Co-Applicant - Own Or Rent
Co-Applicant - Time At Former Address
Co-Applicant - Marital Status
Co-Applicant - Present Employer - Time At Job
Co-Applicant Income Information

Alimony, child support or separate maintenance need not be disclosed unless you wish it to be considered as a basis for repaying this obligation.

Co-Applicant - Alimony child support or separate maintenance received under
Co-Applicant - Other Income
Co-Applicant - Is any of this income likely to be reduced before the credit request is paid off?
Co-Applicant - Have you ever declared bankruptcy in the past 10 years?
Co-Applicant - If YES to bankruptcy
Co-Applicant - Are there any unsatisfied judgements against you?
Co-Applicant - If YES to unsatisfied judgements
Co-Applicant - Are you a Co-Maker, endorser or guarantor on any loan or contract?
Co-Applicant - If YES - to being a Co-Maker
Co-Applicant - Have you had any bad credit over the past 7 years?
Co-Applicant - If YES to bad credit
Co-Applicant - Do you have any contingent liabilities such as pending lawsuits or leases?
Co-Applicant - If YES to contingent liabilities
Assets and Liabilities Information

Green = Value item | Blue = Monthly Payment item | Red = Unpaid Balance item

Checking/Savings At Rolling Hills Bank and Trust
Other Bank/Credit Union Accounts
Bank/Credit Union Loans
Charge Cards
Stocks, Bonds, Retirement, etc.
Vehicles (include YEAR, MAKE, MODEL)
Vehicle Lender(s)
Home
Mortgage Holder or Rent
Other Real Estate Payments
Other Real Estate
Life Insurance
Business
Other Assets (Boats, ATV, Motorcycles, Campers, etc.)
Personal Properties
Child Support or Alimony Payments
TOTALS

Pursuant to the national privacy law that took effect July 1, 2001, I/we authorize Rolling Hills Bank & Trust to obtain verification of any information needed to complete my/our loan request. This information includes but is not limited to my/our bank account, other assets, employment earnings records and the need to order a consumer credit report. I/We further authorize anyone to accept a photocopy or facsimile of this document as their authorization to release such information to Rolling Hills Bank and Trust. I/We have received Rolling Hills Bank and Trust's privacy statement. Rolling Hills Bank & Trust may report information about my/our account to credit bureaus. Late payments, missed payments or other defaults on my/our account may be reflected in my/our credit report.

SIGNATURES — I/We certify that everything I/we have stated in this application and on any attachments is correct. I/We may keep a copy of this application whether or not it is approved. By signing below, I/we authorized you to check my/our credit and employment history and to answer questions others may ask you about my/our credit record with you. I/we understand that I/we must update credit information at your request if my/our financial condition changes.

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Revision Date: June 2014.

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