Dealer Loan Application :: The Citizens 1st National Bank

*Purchase Price

*Interest Rate Type:

Fixed Variable

Trade-in $:

*Quoted Interest Rate:

*Down Payment

*Total Amount Financed $

*Payment Frequency:

Monthly Quarterly Semiannual Annual

*First Payment Due:

*Loan Term (years):

*Required Field

Primary Applicant

*First Name:

Middle Name:

*Last Name:

Business Name:(if applicable)

*Social Security Number:

*Date of Birth:

*Address:

*City:

*State:

*Zip:

*Home Phone:

Cell Phone:

Organization of Business:

Partnership LLC Corporation

*Required Field

Co Applicant (if applicable)

*First Name:

Middle Name:

*Last Name:

Business Name:(if applicable)

*Social Security Number:

*Date of Birth:

*Address:

*City:

*State:

*Zip:

*Home Phone:

Cell Phone:

Organization of Business:

Partnership LLC Corporation

*Required Field

Equipment

*Year:

*Make:

*Model

*Type:

*Serial/VIN

*Insurance Company for equipment/vehicle:

*Insurance Company Phone Number:

*Required Field

Financial

*Main Lending Ref:

*Contact:

*State:

*Gross Farm Income:

*Total Assets $

*Non-farm Income $

*Total Liabilities:

*Have you ever filed bankruptcy?

Yes No

*Current judgements against you?

Yes No

*Required Field

By clicking "Submit", you are claiming that all the information is correct to the best of your knowledge.