To help the government fight the funding of terrorism and money laundering activities, Federal law 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, or apply for a loan, we will ask your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.
This application is designed to be completed by the applicant (s) with the lender's assistance. Please indicate whether you intend to apply for individual or joint credit. Applicants for joint credit should complete the applicable co-borrower sections of the application. Co-borrower information must be provided when the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification, or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the secured property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.
You must be a U. S. Citizen with a U.S. address and Social Security number to apply online All other applicants should contact us at 405-547-2436.
Purpose of Loan:
If other, please explain:
Notice: Do not enter a P. O. Box unless
you are currently serving in the military.
Notice: Marital status should only be completed if applicant
is applying for joint or secured credit, or if applicant resides in
a community property state, or is relying on property located in such
Notice: Do not enter a P. O. Box unless you are currently serving in
Notice: Marital status should only be completed
if applicant is applying for joint or secured credit, or if applicant
resides in a community property state, or is relying on property located
in such a state.
This Statement and any applicable
supporting schedules may be completed jointly by both married and unmarried
Co-Borrowers if their assets and liabilities are sufficiently joined
so that the Statement can be meaningfully and fairly presented on a
combined basis; otherwise separate Statements and Schedules are required.
If the Co-Borrower section was completed about a spouse, this Statement
and supporting schedules must be completed about that spouse also.
Total Assets a.
List the creditor's name, address and account number for all outstanding
debts, including automobile loans, revolving charge accounts, real estate
loans, alimony, child support, stock pledges, etc. Use continuation
sheet, if necessary.
(If Additional Properties Owned Attach Separate Schedule)
(1) What type of property did you own: principle residence (PR)
second home (SH), or investment property(IP)?
(2) How did you hold title to the home: solely by yourself (S),
jointly with spouse (SP), or jointly with another person (O)?
The following information is requested by the Federal Government for
certain types of loans related to a dwelling in order to monitor the
lender’s compliance with equal credit opportunity, fair housing, and
home mortgage disclosure laws. You are not required to furnish this
information, but are encouraged to do so. The law provides that a lender
may discriminate neither on the basis of this information, nor on
whether you choose to furnish it. If you furnish the information, please
provide both ethnicity and race. For race, you may check more than
one designation. If you do not furnish ethnicity, race, or sex,
under Federal regulations, this lender is required to note the
information on the basis of visual observation or surname. If you
do not wish to furnish the information, please check the box below.
The undersigned specifically acknowledge(s) and agree(s) that: (1) the
loan requested by this application will be secured by a first mortgage
or deed of trust on the property described herein; (2) the property will
not be used for any illegal or prohibited purpose or use; (3) all statements
made in this application are made for the purpose of obtaining the loan
indicated herein; (4) occupation of the property will be as indicated
above; (5) verification or reverification of any information contained
in the application may be made at any time by the Lender, its agents,
successors and assigns, either directly or through a credit reporting
agency, from any source named in this application, and the original copy
of this application will be retained by the Lender, even if the loan is
not approved; (6) the Lender, its agents, successors and assigns will
rely on the information contained in the application and I/we have a continuing
obligation to amend and/or supplement the information provided in this
application if any of the material facts which I/we have represented herein
should change prior to closing; (7) in the event my/our payments on the
loan indicated in this application become delinquent, the Lender, Its
agents, successors and assigns, may, in addition to all their other rights
and remedies, report my/our name(s) and account information to a credit
reporting agency; (8) ownership of the loan may be transferred to successor
or assign of the Lender without notice to me and/or the administration
of the loan account may be transferred to an agent, successor or assign
of the Lender without prior notice to me; (9) the Lender, its, agents,
successors and assigns make no representations or warranties, express
or implied, to the Borrower(s) regarding the property, the condition of
the property, or the value of the property.
– Certification: I/We certify that the information provided in this application
is true and correct as of the date set forth opposite my/our signature(s)
on this application and acknowledge my/our understanding that any intentional
or negligent misrepresentation(s) of the information contained in this
application may result in civil liability and/or criminal penalties
including, but not limited to, fine or imprisonment or both under the
provisions of Title 18, United States code, Section 1001, et seq. and
liability for monetary damages to the Lender, its agents, successors
and assigns, insurers and any other person who may suffer any loss due
to reliance upon any misrepresentation which I/we have made on this
© 2021 Payne County Bank. All rights reserved.