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Credit Application
InBank
15533 South Cicero Avenue Oak Forest, Illinois 60452 (708) 687-6000
Member F.D.I.C.
[Closed end, unsecured/secured credit]
CREDIT APPLICATION
IMPORTANT: Read these Directions before completing this Application
If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A and D. If the requested credit is to be secured, also complete the first part of Section C and E.
If you are applying for joint credit with another person, complete all Sections except E, providing information in B about the joint applicant. If the requested credit is to be secured, then complete Section E.

We intend to apply for joint credit:
Applicant
Co-Applicant
If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income of assets of another person as the basis for repayment of the credit requested, complete all Sections except E to the extent possible, providing information in B about the person on whose alimony, support, or separate maintenance payments or income or assets you are relying. If the requested credit is to be secured, then complete Section E.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.
DATE AMOUNT REQUESTED NO. OF MONTHS PURPOSE

Section A - Applicant

General

FULL NAME: NO. OF DEPENDENTS OTHER THAN SELF:
LIST ANY OTHER NAME(S) UNDER WHICH YOU HAVE OBTAINED CREDIT: DATE OF BIRTH:
HOME ADDRESS: ZIP CODE: TIME AT PRESENT ADDRESS: TELEPHONE NO.:
PREVIOUS ADDRESS (IF AT PRESENT ADDRESS LESS THAN TWO YEARS): HOW LONG THERE:
NEAREST RELATION (NOT LIVING WITH YOU): RELATIONSHIP: ADDRESS: TELEPHONE NO.:

IF U.S. PERSON (Complete all that apply):

DRIVER'S LICENSE NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION: SOCIAL SECURITY NO. or TAX I.D. NO.:
STATE ID CARD NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION: OTHER(MILITARY I.D., TRIBAL I.D. ETC.):

IF NON U.S. PERSON (Complete all that apply):

DRIVER'S LICENSE NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION: SOCIAL SECURITY NO. or TAX I.D. NO.:
STATE ID CARD NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION:
PASSPORT NO. & COUNTRY OF ISSUANCE: INDIVIDUAL TAXPAYER I.D. NO.: NO TAXPAYER I.D. NO., BUT HAVE FILED APPLICATION FOR ONE, WHEN FILED: GOVERNMENT ISSUED DOCUMENT NO. AND COUNTRY OF ISSUANCE: OTHER:

Employment

EMPLOYER: ADDRESS:
HOW LONG THERE: SALARY: $ Month Week OCCUPATION OR POSITION: PHONE:
PREVIOUS EMPLOYERS: ADDRESS: HOW LONG THERE:
PREVIOUS EMPLOYERS: ADDRESS: HOW LONG THERE:
INCOME FROM ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE NEED NOT BE REVEALED
IF YOU DO NOT CHOOSE TO RELY UPON IT AS A BASIS FOR REPAYING THIS OBLIGATION.

Other Income

Source: Monthly Amount: $
Source: Monthly Amount: $
DO YOU MAKE ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE PAYMENTS? No Yes Amount:

Section B - Joint Applicant or Other Party

General

FULL NAME: NO. OF DEPENDENTS OTHER THAN SELF:
LIST ANY OTHER NAME(S) UNDER WHICH YOU HAVE OBTAINED CREDIT: DATE OF BIRTH:
HOME ADDRESS: ZIP CODE: TIME AT PRESENT ADDRESS: TELEPHONE NO.:
PREVIOUS ADDRESS (IF AT PRESENT ADDRESS LESS THAN TWO YEARS): HOW LONG THERE:
NEAREST RELATION (NOT LIVING WITH YOU): RELATIONSHIP: ADDRESS: TELEPHONE NO.:

IF U.S. PERSON (Complete all that apply):

DRIVER'S LICENSE NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION: SOCIAL SECURITY NO. or TAX I.D. NO.:
STATE ID CARD NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION: OTHER(MILITARY I.D., TRIBAL I.D. ETC.):

IF NON U.S. PERSON (Complete all that apply):

DRIVER'S LICENSE NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION: SOCIAL SECURITY NO. or TAX I.D. NO.:
STATE ID CARD NO.: STATE: DATE OF ISSUANCE: DATE OF EXPIRATION:
PASSPORT NO. & COUNTRY OF ISSUANCE: INDIVIDUAL TAXPAYER I.D. NO.: NO TAXPAYER I.D. NO., BUT HAVE FILED APPLICATION FOR ONE, WHEN FILED: GOVERNMENT ISSUED DOCUMENT NO. AND COUNTRY OF ISSUANCE: OTHER:

Employment

EMPLOYER: ADDRESS:
HOW LONG THERE: SALARY: $ Month Week OCCUPATION OR POSITION: PHONE:
PREVIOUS EMPLOYERS: ADDRESS: HOW LONG THERE:
PREVIOUS EMPLOYERS: ADDRESS: HOW LONG THERE:
INCOME FROM ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE NEED NOT BE REVEALED
IF YOU DO NOT CHOOSE TO RELY UPON IT AS A BASIS FOR REPAYING THIS OBLIGATION.

Other Income

Source: Monthly Amount: $
Source: Monthly Amount: $
DO YOU MAKE ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE PAYMENTS? No Yes Amount:

Section C - Marital Status - DO NOT COMPLETE IF THIS IS AN APPLICATION FOR INDIVIDUAL UNSECURED CREDIT.

APPLICANT MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED)
OTHER PARTY MARRIED SEPARATED UNMARRIED (INCLUDING SINGLE, DIVORCED, AND WIDOWED)
USE THIS SPACE FOR ADDITIONAL EXPLANATION IF NEEDED:

Section D - Asset and Debt Information

IF SECTION B HAS BEEN COMPLETED, THIS SECTION SHOULD BE COMPLETED GIVING INFORMATION ABOUT BOTH THE APPLICANT AND JOINT APPLICANT OR OTHER PERSON. PLEASE MARK APPLICANT-RELATED INFORMATION WITH AN "A". IF SECTION B WAS NOT COMPLETED, ONLY GIVE INFORMATION ABOUT THE APPLICANT IN THIS SECTION.

Assets Owned

  DESCRIPTION OF ASSETS   VALUE SUBJECT TO DEBT?
No or Yes		 NAME(S) OF OWNER(S)
CASH: $ No Yes
AUTOMOBILES (MAKE, MODEL, YEAR): $ No Yes
CASH VALUE OF LIFE INSURANCE (ISSUER, FACE VALUE): $ No Yes
REAL ESTATE (LOCATION, DATE ACQUIRED): $ No Yes
MARKETABLE SECURITIES (ISSUER, TYPE, NO. OF SHARES): $ No Yes
OTHERS (LIST): $ No Yes
TOTAL ASSETS:   $  

Outstanding Debts

(INCLUDE CHARGE ACCOUNTS, INSTALLMENT CONTRACTS, CREDIT CARDS, RENT, MORTGAGES ETC.)
CREDITOR TYPE OF DEBT OR ACCOUNT NO. NAME IN WHICH ACCOUNT CARRIED ORIGINAL DEBT PRESENT BALANCE MONTHLY PAYMENTS PAST DUE?
No or Yes
(LANDLORD OR MORTGAGE HOLDER)
 RENT PAYMENT
MORTGAGE

$		 (OMIT RENT)
$		 (OMIT RENT)
$
No Yes
$ $ $ No Yes
$ $ $ No Yes
$ $ $ No Yes
TOTAL DEBTS: $ $ $
CREDIT REFERENCES DATE PAID
$
$
ARE YOU A CO-MAKER, ENDORSER OR GUARANTOR ON ANY LOAN OR CONTRACT?
No
Yes		 IF YES, EXPLAIN:
ARE THERE ANY UNSATISFIED JUDGEMENTS AGAINST YOU?
No
Yes		 IF YES, EXPLAIN:
HAVE YOU EVER GONE THROUGH BANKRUPTCY OR CHAPTER XIII?
No
Yes		 IF YES, EXPLAIN - WHERE AND WHAT YEAR:

Section E - Secured Credit (COMPLETE ONLY IF CREDIT IS TO BE SECURED)

BRIEFLY DESCRIBE THE PROPERTY TO BE GIVEN AS SECURITY:
AND LIST NAMES AND ADDRESS OF ALL CO-OWNERS OF THE PROPERTY:
IF THE SECURITY IS REAL ESTATE GIVE THE FULL NAME OF YOUR SPOUSE (IF ANY):
NOTICE: 18 UNITED STATES CODE 1014, PRESCRIBES CRIMINAL PENALTIES FOR FALSE STATEMENTS IN LOAN APPLICATION TO FEDERALLY INSURED BANKS. I/WE HEREBY CERTIFYTHATTHE FOREGOING ARE TRUE AND COMPLETE AND ARE MADE FOR THE PURPOSE OF DETERMINING MY/OUR ELIGIBILITY FOR CREDIT. I/WE AGREE THAT THIS STATEMENT SHALL REMAIN YOUR PROPERTY, WHETHER OR NOT THE APPLICATION IS ACCEPTED. YOU ARE AUTHORIZED TO MAKE ALL INQUIRIES YOU DEEM NECESSARY TO VERIFY THE ACCURACY OF THE STATEMENTS MADE HEREIN, AND TO DETERMINE MY/OUR CREDIT WORTHINESS, INCLUDING, BUT NOT LIMITED TO, PROCURING CONSUMER REPORTS FROM CONSUMER REPORTING AGENCIES AND CREDIT INFORMATION FROM BANKS AND OTHER FINANCIAL INSTITUTIONS AND EXTENDERS OF CREDIT, REFERENCES, PRESENT AND FORMER EMPLOYERS, MERCHANTS, LANDLORDS AND CREDITORS. EACH APPLICANT CONSENTS THAT, UPON DENIAL OF THE APPLICATION BASED UPON A CONSUMER REPORT OR INFORMATION RECEIVED FROM A PERSON OTHER THAN A CONSUMER REPORTING AGENCY ON ANY APPLICANT CREDITOR MAY MAKE APPROPRIATE FAIR CREDIT REPORTING ACT DISCLOSURES TO ALL APPLICANTS.

Signature of Applicant
Date

Signature of Joint Applicant
Date


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