Quick Loan Request Form




Loan Request Form










© 2016 First Bank Kansas, All Rights Reserved

First Bank Kansas
Loan Request Form

Disclaimer: The Quick Loan Request form is not to be considered a completed application for ANY loan types. A completed application will be required after contact has been made. Expect contact time to be within 1-3 business days. NMLS# 528128.
$ Amount Applying For
 No. of Months
 Collateral (Home, Land, Auto, Unsecured, etc.)
Purpose of Loan

Home:
Purchase Refinance Construction Line of Credit Home ImprovementOther (explain)
Is this residence your: Primary Secondary Investment

Consumer:
Auto Recreational Unsecured Land Other (explain)
Commercial:
Vehicle Equipment Real Estate Operating Line Agriculture Other (explain)
What bank do you currently use for your primary checking account?

Purchase Price (if applicable)
$
Borrower’s Name
 Social Security No.
Date of Birth
 Contact Phone
Email
Present Address (Street, State, ZIP)


Own
Rent
No. Yrs.
Name & Address of Employer

Self Employed
Co-Borrower’s Name
 Social Security No.
Date of Birth
 Contact Phone
Email
Present Address (Street, State, ZIP)


Own
Rent
No. Yrs.
Name & Address of Employer

Self Employed
Gross Monthly Income Borrower Co-Borrower Total
$
 $
 $
Acknowledgement and Agreement

To be completed and submitted by Borrowers

Everything that I have stated in this request form is correct to the best of my knowledge. I understand that you will retain this information in addition to the full application once it is completed. You are authorized to check my credit and employment history and answer questions about your credit experience with me.
Borrower’s Name
 Date
 Co-Borrower’s Name
 Date