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IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING AN ACCOUNT AT THE STATE BANK OF CROSS PLAINS

In an effort to assist the government with its fight to stop the funding of terrorism and money laundering activities, the State Bank of Cross Plains will abide by the USA PATRIOT Act, a Federal law that 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 we will ask for 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. If you are opening an account on behalf of a business entity, documents relating to the business may also be requested. In all cases, protection of our customer's identity and confidentiality is the bank's commitment to you. Applicants must be at least 18 years or older in order to apply online.

9/2003

At the State Bank of Cross Plains, service is important to us. If you would like to get started opening a loan account, please complete the information below, press the submit button to send your form to the State Bank of Cross Plains, and one of our lenders will contact you to set up an appointment. If you are interested in applying for a Home Equity loan, please contact one of our loan representatives to apply. All of our forms are completely secured. However, if you prefer, you may print this form and mail or fax it to us.

State Bank of Cross Plains
Attn: Consumer Loan Department
1205 Main Street
Cross Plains, WI 53528
FAX# (608) 798-3591

You may apply for separate of joint credit.  Please check the appropriate selection below.
Separate Credit - Complete Applicant column and sign below.  Complete spouse column only if are a married Wisconsin resident.
Joint Credit with Spouse - Complete Applicant and Spouse Columns.  Both the applicant and the spouse must sign below.
Joint Credit with___________________ who is not your spouse.  Both applicants must complete separate applications and submit them together.
Amount Requested: $
Purpose of Loan:
Description of collateral to secure loan:
Desired Term:
Today's Date (mm/dd/yy):

Applicant Information
Name:
Date of Birth (mm/dd/yy):
Marital Status:
Home Phone:
Social Security Number:
Driver's License Number:
Current Street Address:
City:
State: Zip Code:
How Long: Years   Months
Email Address:
Landlord/ Mortgage Holder:
Monthly Mort. Payment
Monthly Rent Payment
Previous Street Address:
City:
State: Zip Code:
How Long: Years   Months
Current Employer:
Business Phone:
Employer Street Address:
City:
State: Zip Code:
Years There:
Position/ Title:
*Monthly Gross Salary: $: per:

*Other income such as alimony, child support, or separate maintenance payments need not be revealed if you are not relying on it to repay this loan.
Other Monthly Income: $:
Other Income Source:
Previous Employer:
Years There:
Street Address:
City:
State:
Zip Code:
Bank Name:
Checking Account #:
Checking Balance: $:
Savings Account #:

Applicant References List all open accounts and any closed accounts you want considered.
Vehicle/Boat Loans
Year/ Make/ Model:
Financed by:
Monthly Payment: $
Current Balance $
Year/ Make/ Model:
Financed by:
Monthly Payment: $
Current Balance $
Other Loans or Debts
Name of Creditor
Monthly Payment: $
Current Balance: $
Name of Creditor
Monthly Payment: $
Current Balance: $
Name of Creditor
Monthly Payment: $
Current Balance: $

Spouse Information
Name:
Co Applicant/ Non-Applicant Co Applicant Non-Applicant
Marital Status (check one): Married  Unmarried  Legally Separated
Home Phone:
Date of Birth (mm/dd/yy):
Social Security Number:
Driver's License Number:
Current Street Address:
City:
State: Zip Code:
How Long: Years   Months
Email Address:
Landlord/ Mortgage Holder:
Monthly Mort. Payment
Monthly Rent Payment
Previous Street Address:
City:
State: Zip Code:
How Long: Years   Months
Current Employer:
Business Phone:
Employer Street Address:
City:
State: Zip Code:
Years There:
Position/ Title:
*Monthly Gross Salary: $: per:

*Other income such as alimony, child support, or separate maintenance payments need not be revealed if you are not relying on it to repay this loan.
Other Monthly Income: $:
Other Income Source:
Previous Employer:
Years There:
Street Address:
City:
State:
Zip Code:
Bank Name:
Checking Account #:
Checking Balance: $:
Savings Account #:

Spousal References - List all open accounts and any closed accounts you want considered.

Vehicle/Boat Loans
Year/ Make/ Model:
Financed by:
Monthly Payment: $
Current Balance $
Year/ Make/ Model:
Financed by:
Monthly Payment: $
Current Balance $
Other Loans or Debts
Name of Creditor
Monthly Payment: $
Current Balance: $
Name of Creditor
Monthly Payment: $
Current Balance: $
Name of Creditor
Monthly Payment: $
Current Balance: $

NOTICE TO MARRIED APPLICANTS:

No provision of any marital property agreement, unilateral statement under Section 766.59, Wisconsin Statutes or court decree under Section 766.70, Wisconsin Statues, adversely affects the interest of the creditor; unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.

I have read the above disclosure: Yes No

CERTIFICATION:

The undersigned certify that the above statements are true and complete.  The undersigned understand that it may be a federal crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts, under the provisions of Title 18, United States Code, Section 1014.

I have read the above disclosure:  Yes  No

AUTHORIZATION:

I hereby authorize State Bank of Cross Plains (the "creditor") or its agents to verify my past and present employment earnings records, employment, bank accounts, stock holdings, and any other asset balances that are needed to process my loan application.  I further authorize State Bank of Cross Plains to order a consumer credit report and verify other credit information.  The State Bank of Cross Plains may furnish such information and any other credit experience with others, and answer any questions about other financial relationships with the creditor.

The undersigned agree to the provisions of any rules, regulations, or agreements of the creditor governing such credit.

This application is the property of the State Bank of Cross Plains.

I have read the above disclosure:  Yes  No

NOTICE TO WISCONSIN MARRIED APPLICANTS:

The credit being applied for, if granted, will be incurred in the interest of my marriage or family.  I understand the creditor may be required by law to give notice of this credit transaction to my spouse.

I have read the above disclosure:  Yes  No

You have applied for an extension of credit with us. We are soliciting, offering, or selling you an insurance product or annuity in connection with this extension of credit.

WE ARE PROHIBITED FROM CONDITIONING THE EXTENSION OF CREDIT ON EITHER:

  1.   The purchase of an insurance product or annuity from us or from any of our affiliates; or
  2.   The agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.

I have read the above disclosure: Yes No

What is the best time and way to get a hold of you?

 

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