Loan Application - Farmers & Merchants State Bank

Pre-Qualification Application

All fields with an asterisk (*) are required

Are you currently working with a Real Estate Agent? Yes No

Borrower Information

First Name	*

Middle Initial

Last Name	*

Street	*

City	*

State	*

Zip Code	*

Home Phone	*

Mobile Phone	*

E-mail Address	*

S.S. #	*

Birth Date	*

Marital Status

Years at Location	Under Two Over Two *

Rent or Own	Own Rent

Assets and Income

Monthly Income	(Gross) *

Sources of Income *	Self-employed Commissions Salary Hourly Other

Employer	*

Job Title	*

Years at Position	*

Assets	Checking/Savings Balance Market Value of Real Estate Other Assets

Co-Borrower Information

First Name

Middle Initial

Last Name

Street

City

State

Zip Code	Copy Borrower Address

Home Phone

Mobile Phone

E-mail Address

S.S. #

Birth Date

Marital Status

Years at Location	Under Two Over Two

Rent or Own	Own Rent

Assets and Income

Monthly Income	(Gross)

Sources of Income	Self-employed Commissions Salary Hourly Other

Employer

Job Title

Years at Position

Assets	Checking/Savings Balance Market Value of Real Estate Other Assets

Questions or Comments

By submitting this loan application form, you are giving Farmers & Merchants State Bank authorization to run a credit check on your financial history.

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