Wells Federal Bank
Internet Installment Loan Application

Loan Services are available throughout the bank's regular service area.
Contact the bank for specific information regarding this service area.

This form data is sent without encrypting it for privacy.
You may not want to submit sensitive or private information via this form.

Which Branch Office?
Loan Amount Auto Year
Term Mileage
Purpose Make
Model
Serial
License #

PART I

First Name

Middle Initial

Last Name

Social Security Number Driver's License Number
Current Address Previous Address (if less than 2 years)
Street Address
City
State
Zip
How Long
Date of Birth Home or Nearby Phone

Employed By

Employer's Address

Position
Salary How Long with Employer
Last Employer (If employed less than 3 years)
How Long

Amount of other income

Sources of other income (you need not reveal alimony, child support or maintenance payments)

Bank Reference - Name of Bank

Type of Account
Status of account
List below all contracts or loans on which you are now making payments
(include auto, furniture, home improvements, credit line, clothing, etc.)
Payments Made To Address Purpose Unpaid Balance Monthly Payment
Is this all you owe? (y/n) Total of other indebtedness
Monthly Mortgage Payment Value
Balance Mortgage Holder
Monthly Rent Payment Landlord
Address

PART II

Co-applicant: 
Co-applicant's address, if different from applicants
Birthdate Co-app's Employer
Position How Long Employed
Co-applicant salary Phone
Employer's Address Social Security #

PART III

By submitting this application electronically I authorize Wells Federal Bank to check my credit and employment history and to answer questions about your credit experience with me.

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