Loan Application

New Account Procedures For Opening A New Account

The USA Patriot Act requires all financial institutions to help in the fight against money laundering activities, identity theft, and the spread of terrorism. This law requires all financial institutions to obtain, verify and record more information from an individual or legal entity to help establish identity.

We are asking for your help when you open a new account or request a loan. We will ask for your full legal name, your physical and mailing addresses, date of birth and we may ask for additional information to help establish and confirm your identity.

All new customers are encouraged to stop into any of our six locations in Wisconsin for verification purposes. We may also require you to provide your driver's license or other forms of identification.

Thank you!

Please provide all the requested information. When you have completed the form, press the Submit button to send your form to Farmers Savings Bank. All our online forms use the newest Internet Security. However, if you prefer, you may print this form out and mail or fax to the address below. Upon receipt of your request one of our knowledgeable Personal Bankers will contact you.

Farmers Savings Bank
PO Box 251
Mineral Point, WI 53565-0251
FAX# (608) 987-2401

May we suggest a credit card for loan amounts under $2,000.

Please be advised that at this time, applicants must be legal residents of the State of Wisconsin.

Open Account Form

(If opening multiple accounts, please use a separate form for each account.)

Loan Information:  
Will there be a co-applicant on this loan application?:

Loan Amount:

$ Please enter a loan amount.
Purpose of Loan:
Collateral:
Length of Loan:
Credit Type:  
You may apply for individual or joint credit, but choose only one of the following, thank you.  
Individual Credit - unmarried applicant
Individual Credit - married applicant
Joint Credit - with your spouse
Joint Credit - with an applicant or cosigner who is not your spouse
  Notice to married applicant: No provision of a marital property agreement, a unilateral statement under Wis. State. sec 766.59 or a court decree under Wis Stat. sec 766.70 adversely affects the interests of the bank unless prior to the time the credit is extended, the bank is furnished with a copy of the agreement statement or decree, or has actual knowledge of the adverse provision when the obligation to the credit union is incurred.
Personal Information:  
First Name:
Please enter your first name
Middle Initial:
Last Name:
Please enter your last name.
Address:
City:
State:
ZIP:
Country:
How Long?
If you have lived at your current address less than 2 years, please provide your previous home address:
Previous Address:
Previous City:
Previous State:
Previous ZIP:
Previous Country:
Marital Status: Married
Unmarried (includes single, widowed, and divorced)
Home Phone Number:
Work Phone Number:
Social Security Number:
Taxpayer ID Number
(if different from SSN):
Date of Birth (00/00/00)::

Mother's Maiden Name for account verification::

Employment Information:  
Work Phone Number:
Employer Name:
Address:
City:
State:
ZIP:
Position:
How Long Employed?:
If you have worked for this employer less than 2 years, please provide previous employment history.
Income & Asset Information:  
Gross Monthly Pay:
Other Income:
Note: 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 obligaion.
Savings / Checking Balance:
Real Estate - locations, value:
Automobile - Year, Make, Model:
Other Asset:
Other Asset:
   
Debt Information: List all debts and credit accounts, use blanks provided for descriptions. If descriptions listed do not apply, please say "None" for the balance & payment.
Description Balance Monthly Payment

Rent or Mortgage

Credit Card

Auto Payment

Child Support / Alimony

Separate Maintenace Payment

If this is a joint loan application, please fill out the following section as well. Thank you!
   
Joint Account Personal Information: If your loan application is for joint credit, for individual credit relying on income or assets from other sources, or you are married and reside in a community property state, you must also fill out this section of the application.  If you are applying for individual credit, you can skip this section. 
First Name:
Middle Initial:
Last Name:
Address:
City:
State:
ZIP:
Country:
How Long?
E-Mail:
Home Phone Number:
Work Phone Number:
Social Security Number:
Taxpayer ID Number
(if different from SSN):
Date of Birth (00/00/00)::
If you have lived at your current address less than 2 years, please provide your previous home address:
Previous Address:
Previous City:
Previous State:
Previous ZIP:
Previous Country:
Marital Stattus: Married
Unmarried (includes single, widowed, and divorced)
Joint Employment Information:  
Employer Phone Number:
Employer Name:
Address:
City:
State:
ZIP:
Position:
Salary Per Month:
How Long Employed:
If you have worked for this employer less than 2 years, please provide previous employment history.
Source of Other Income: Note: 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 obligaion.
Amount Per Month:
   
Income & Asset Information:  
Gross Monthly Pay:
Other Income:
Note: 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 obligaion.
Savings / Checking Balance:
Real Estate - locations, value:
Automobile - Year, Make, Model:
Other Asset:
Other Asset:
   
Debt Information: List all debts and credit accounts, use blanks provided for descriptions. If descriptions listed do not apply, please say "None" for the balance & payment.
Description Balance Monthly Payment

Rent or Mortgage

Credit Card

Auto Payment

Child Support / Alimony

Separate Maintenace Payment

   
Payment Option
Automatic Loan Payment Method:  

You do not have to select an automatic payment method to obtain credit. These are offered to you as a service from our institution. We will contact you with full details on this method of payment if you select it as an option. (If your institution offers lower rates for this payment method, note that here)

Automatic Loan Payment (Payment is transferred monthly on the due date.)

Any comments or question you may have for us?

By submitting this application, I/We certify that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize Farmers Savings Bank to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for, or for any other services offered. This application does not constitute a contract for the extension of credit.

Thank You. Upon receipt of this application, someone at Farmers Savings Bank will review your information and get back to you to extend credit, with additional questions or to request further information. We appreciate this opportunity to be your financial partner.

         

 

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