Contact Info

The Grant County Bank Disclosure

Loan Information

Applicant Information

Applicant Employment

Co-Applicant Information

Co-Applicant Employment

Other Income

Housing Information

Cash Asset Information

Assets

Assets Stocks and Bonds

Assets Automobiles Owned

Assets Other Assets Owned

Liabilities

Liabilities Continued

Signers

Let's start with a little information about you.

First Name * Required

Middle Name Required

Last Name * Required

Email Address * Required

Confirm Email Address * Required

Address Line 1 * Required

Address Line 2

City * Required

State * Required

Zip * Required

Date of Birth *Invalid Date

Social Security Number *Required

Phone Number *Required

We only facilitate loans to residents of Grant, Mineral, Hardy, Pendleton, Tucker, Hampshire & Randolph Counties in WV.

We only initiate online applications to residents of Grant, Mineral, Hardy, Pendleton, Tucker, Hampshire & Randolph Counties in WVdleton, Tucker, Hampshire & Randolph Counties in WV. * Required

Please answer all relevant questions

Credit Requested is * Required

Joint application ? * Required

Amount Requested * Required

$

Description Of Collateral Offered Required

Year of Collateral Required

Make * Required

Model Required

State of Title * Required

VIN If known Required

Market Value Required

Purpose of Credit Requested * Required

Loan Officer name if known Required

Please answer all relevant questions

Applicant Role * Required

Marital status * Required

Number of Dependents Required

Ages of Dependents Required

Citizenship * Required

How long have you been at Present Address (Years) * Required

Mailing Address if different from Present Address Required

Former Address if less than 2 years Required

From date Required

To Date Required

Please answer all the questions.

Employers Name and Address Required

Are you Self Employed Required

Numbers of Years on this Job Required

Full Time Required

Position/Title and Type of Business Required

Business Phone Number Required

Gross Monthly Income Required

$

Employers Name and Address 2 Required

Self Employed Required

From Date Required

To Date Required

Position/Title and Type of Business Required

Business Phone Number Required

Employers Name and Address 3 Required

Self Employed Required

From Date Required

To Date Required

Position/Title and Type of Business Required

Business Phone Number Required

Please answer only if applying jointly.

Please answer all relevant

Alimony, Child support or separate maintenance Income need not be revealed

Other Income 1 Required

Amount Required

$

Other Income 2 Required

Amount Required

$

Other Income 3 Required

Amount Required

$

Other Income 4 Required

Amount Required

$

Other Income 5 Required

Amount Required

$

Other Income 6 Required

Amount Required

$

Current Housing Information

Own/ Rent Required

Since Required

Monthly Housing cost /Rent Required

$

Present Value Required

Date Purchased Required

Please answer all relevant questions

Financial Institution Name Required

Savings account Balance Required

$

Checking Account Balance Required

$

Please answer all relevant questions

Name and Address of Institution 1 Required

Account Number Required

Cash or Market Value Required

$

Name and Address of Institution 2 Required

Account Number Required

Cash or Market Value Required

$

Name and Address of Institution 3 Required

Account Number Required

Cash or Market Value Required

$

Name and Address of Institution 4 Required

Account Number Required

Cash or Market Value Required

$

Name and Address of Institution 5 Required

Account Number Required

Cash or Market Value Required

$

Please answer all relevant questions

Life Insurance Face Value Required

$

Real Estate Owned Assets Required

$

Vested Interest in Retirement Funds Required

$

Net Worth of Businesses Owned Required

$

Number and Description Required

Cash or Market Value Required

$

Number and Description Required

Cash or Market Value Required

$

Number and Description Required

Cash or Market Value Required

$

Number and Description Required

Cash or Market Value Required

$

Please answer all relevant questions

Year make and Model Required

Cash or Market Value Required

$

Year make and Model Required

Cash or Market Value Required

$

Year make and Model Required

Cash or Market Value Required

$

Year make and Model Required

Cash or Market Value Required

$

Please answer all relevant questions

Description Required

Cash or Market Value Required

$

Description Required

Cash or Market Value Required

$

Description Required

Cash or Market Value Required

$

Description Required

Cash or Market Value Required

$

Description Required

Cash or Market Value Required

$

Description Required

Cash or Market Value Required

$