Almost a Bank Application

Soc. Security *

Amount Requested *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

How long have you been at your current residence? *

List previous address if you have been at your current address less than 3 years

Date of Birth * +

Driver's License # / State of Issue *

Expiration Date * +

Name of Bank *

How long have you had the account? *

Are there any other signers on the account? *

Yes

No

Other signer's full name

Routing # *

Account # *

Employer (Source of Income) *

How long have you been with this employer? *

Title/Position *

Work Phone

Extension

How often are you paid? *

Other

Take Home Pay *

Next Pay Date * +

Have you ever filed Bankruptcy? *

Yes

No

Bankruptcy File Date +

Are you in Bankruptcy now? *

Yes

No

Full Time/Part Time Shift *

Supervisor's Name *

Supervisor's Phone *

Extension

Application can not be accepted if this portion is not completely filled out/

Reference 1

Reference 1 Name *

Reference 1 Address *

Reference 1 Phone Number *

Reference 1 Relation *

Reference 2

Reference 2 Name

Reference 2 Address

Reference 2 Phone Number

Reference 2 Relation

Reference 3

Reference 3 Name

Reference 3 Address

Reference 3 Phone Number

Reference 3 Relation

Reference 4

Reference 4 Name

Reference 4 Address

Reference 4 Phone Number

Reference 4 Relation

Landlord/Mortgage

Landlord/Mortgage Name *

Reference 4 Address *

Reference 4 Phone Number *

Reference 4 Relation *

How did you hear about us? Check all that apply. *

Business Partner

Referred by Name

How many miles do you live from our location? *

Military Verification: By initialing below, please verify that you are NOT an ACTIVE member of the military services of the United States or the spouse or other dependent of an ACTIVE duty military member.

Prerecorded Messages and Text Messages: Please initial if you would like to receive pre-recorded messages and or text messages, including reminders. notices, and special offers to the numbers listed on this application.

Credit Inquires and Reporting Authorization: You authorize us to obtain credit history reports from credit bureaus and other credit reporting agencies and companies for credit evaluation purposes. Almost A Bank performs such a search in the Veris System. Veris software verifies if a social security number has been assigned, where, when and whom it was assigned. It also reports if the social security number has been reported as deceased.

Notice of Furnishing Negative Information: We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.

Contact Authorization: You authorize Almost A Bank to contact anyone listed on this application.

Privacy Policy: You verify that you have received a copy of Almost A Bank's Privacy Policy.

PLEASE READ CAREFULLY:

This application is being submitted to obtain credit and I certify that all information I have provided is true and complete. By applying for credit from Almost A Bank (the Company) I authorize the Company, it's representatives, agents and assignees, to verify the information and the references I have provided and to obtain credit information both now and in the future for any legitimate purpose associated with this application or the credit transaction, including but not limited to reviewing, renewing or collecting on the credit transaction. I understand that if the Company approves this application, the terms and conditions applicable to the credit transaction will be set forth in the Federal Truth-in-Lending Disclosures and Customer Agreement, which I agree to read before signing. I understand that I must update my credit information at your request if my financial condition changes. I understand that the Company will retain this application whether or not it is approved. I acknowledge that this application and any supporting documentation provided with it is the property of the Company. I understant that by signing below I agree to all the terms set forth herein.

Applicant's Signature *

clear

Sign Date * +

Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); or because all or part of the applicant's income derives from any publicssistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington DC 20580