Note: Alimony, Child Support or Separate Maintenance Income(s) do not have to be revealed unless you wish to have them considered in loan qualification.
I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance product or annuity in connection with this extension of credit. Federal law prohibits you from conditioning the extension of credit on either:
By signing, I acknowledge that I have recieved a copy of this form on today's date. Unless this disclosure is provided electronically or I have applied for credit by mail, I also acknowledge that you have provided this disclosure to me orally.
I certify that all information provided by me is true, correct, and complete. I authorize Fowler State Bank to make whatever inquiries about me they deem necessary and appropriate for the purpose of evaluating my credit application, including credit reports and contacting my employer. I also authorize Fowler State Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies.
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