Personal Loan Application

Please fill out the fields in the form to the right. One of our representatives will contact you within one business day to complete the process. This form supports the maximum level of encryption technology your browser allows, up to 256-bit SSL encryption to protect your personal information while it is in transit. Please view our Privacy Policy for more information.

Type of Credit Requested *

Type of Loan

Individual or Joint *

Amount Requested: *

Term of Loan (in months): *

Payment Date Desired:

Optional

Proceeds of Loan to Be Used For: *

Referred By:

Optional

Name *

First

Middle

Last

Social Security Number *

Date of Birth *

Email *

Driver's License Number *

Choose the location you would like to complete your application *

How would you prefer to be contacted? *

When is the best time to arrange an appointment? *

Home Address (Not a P.O. Box) *

City *

State *

County *

Years at Home Address *

Do you *

Own
Rent

Employer's Name *

Employer's Phone Number *

Employer's Address *

City *

State *

Zip Code *

Your Position *

Years at Company *

Gross Salary Per Month *

Net Salary Per Month *

Alimony, child support, separate maintenance income received under: *

None
Court Order
Written
Oral Understanding

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 obligation.

Have you previously received credit from us? *

No
Yes

Applicant Marital Status

*OPTIONAL*Complete only if: for joint or secured credit, or applicant resides in a community property state, or is relying on property located in such a state as a basis for repayment of the credit requested.

Co-Applicant Marital Status

*OPTIONAL*Complete only if: for joint or secured credit, or applicant resides in a community property state, or is relying on property located in such a state as a basis for repayment of the credit requested.

Secured Credit *

By clicking Submit below, I certify that everything I have stated in this application is correct. Grand Rivers Community Bank may keep this application whether or not it is approved. By submitting this application I authorize Grand Rivers Community Bank to check my credit and employment history and to answer questions others may ask Grand Rivers Community Bank about my credit record with Grand Rivers Community Bank. I understand that I must update credit information at the request of Grand Rivers Community Bank if my financial condition changes. *

Name