Thank you for your interest in applying for a Consumer Loan with FCNB Bank! Please complete the following form with as much information as possible. Once we receive your submission, a Loan Officer will contact you to finalize the application process.



IMPORTANT INFORMATION ABOUT INSURANCE SALES PRACTICES

Please read this carefully.

If you choose to purchase insurance related to this loan, you may do so from any insurance provider. FCNB Bank will not condition the approval of your loan application on your purchase of any type of insurance product from FCNB Bank or any of its affiliates.

The insurance product you may apply for is not a deposit or obligation of, or guarantee by FCNB Bank or its affiliate and is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, FCNB Bank, or an affiliate of FCNB Bank.

When you sign below, you state that you have read this disclosure, and understand its contents, as evidenced by your consent below. A copy of this disclosure has been presented to you at the time of application and may be provided to you again at closing. You understand that this acknowledgement will be made a permanent part of your loan application.

Applicant(Required)
Co-Applicant
JOINT CREDIT NOTICE (if applicable)

If you are applying for joint credit, please sign below to acknowledge your intention. This includes all co­borrower(s}, co-signer(s) and/or guarantor(s) for the loan.

Applicant
Co-Applicant

CONSUMER LOAN APPLICATION

Credit Requested Is(Required)
Account Requested(Required)

If the Applicant is married, he or she may apply for individual credit. For Marital Status, check one if a) you are applying for secured credit; b) you reside in a community property state; or c) you are relying on property in a community property state as a basis for repayment of the credit requested.

APPLICANT INFORMATION

Applicant
Applicant Role(Required)
Applicant Name(Required)
(include Jr. or Sr. if applicable)
Relationship Status(Required)
Number of Dependents and Ages
(not listed by Co-Applicant)
Citizenship(Required)
Present Address(Required)
Mailing Address
If different from Present Address

If residing at present address for less than two years, complete the following:

Former Address
Co-Applicant
Applicant Role
Co-Applicant Name
(include Jr. or Sr. if applicable)
Relationship Status
Number of Dependents and Ages
(not listed by Co-Applicant)
Citizenship
Present Address
Mailing Address, if different from Present Address

If residing at present address for less than two years, complete the following:

Former Address

EMPLOYMENT/INCOME INFORMATION

Applicant
Address of Employer
Self Employed
Status(Required)
Address of Employer
Self Employed
Status
Address of Employer
Self Employed
Status

NOTICE: Alimony, Child Support or Separate Maintenance Income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Income
Other Income
Amount
 
Co-Applicant
Address of Employer
Self Employed
Status
Address of Employer
Self Employed
Status
Address of Employer
Self Employed
Status

NOTICE: Alimony, Child Support or Separate Maintenance Income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Income
Other Income
Amount
 

HOUSING INFORMATION

Own or Rent

CASH ASSET INFORMATION

Account Information
Financial Institution Name
Saving Account Balance
Checking Account Balance
 

To complete this Consumer Loan Application, you will be requested to provide a complete listing of your assets and liabilities. A loan officer will contact you with more information.

DRIVER'S LICENSE UPLOAD

Please upload an image of the front of the Applicant & Co-Applicant Driver Licenses (other IDs may be acceptable)
Accepted file types: jpg, jpeg, png, Max. file size: 8 MB.
Max. file size: 8 MB.

I/We hereby apply for the loan or credit described in this application. I/We certify that I/We made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.

Consent(Required)
Consent