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Loan Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application for processing. If you prefer, you can  print out this information and mail to:

Central National Bank

ATTN: Online Services Department
800 SE Quincy
Topeka, KS 66612

 

Phone 1-888-262-5456
Fax 785-231-1414

 

Before submitting an account opening form, please read and print the Disclosures that pertain to your new account.

 
Application Type    
Today's Date (xx/xx/xxxx)
Loan Information
Do you intend to apply for joint credit?            
Amount Requested  (minimum loan amount $2,500)
Purpose          
Purpose Description
Collateral
Collateral Description
Length of Loan Requested
Personal Information
Name
Social Security Number
Driver's License Number
Driver's License State
Marital Status
 Important: Do not complete for individual unsecured credit.
Married
Unmarried  (includes single, widowed and divorced)
Separated
Birth date (xx/xx/xxxx)
Home Address
City
State
Zip
Home Phone Number
Years/months at current address?
Own or Rent?  Own   Rent
Name of Landlord or Mortgage holder
If you've lived at your current address less than 2 years, please provide your previous home address
Previous Home Address
City
State
Zip
Have you ever filed for bankruptcy or had any judgments filed against you? Yes
No
Name of nearest relative not living with you
Address
City
State
Zip
Phone
Relation to you:
Current Employment Information
Work Phone Number
Employer name
Address
City
State
Zip
Position
Gross Monthly Pay
Years/months employed
If employed less than 2 year at current employer:
Previous Employer
Length of employment
If applying for an Auto Loan:
Purchase Price
Down Payment
Are you trading in a vehicle? Yes   No
Trade in:
   Year        Make   
Model    Mileage
Purchase vehicle:
   Year        Make   
Model    Mileage
Other Income & Asset Information
Other income  per month amount Note: 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.
Source of other income
Real Estate- locations, value
Debt Information - List all debts and credit accounts, replacing "Other" with description. If those listed do not apply, please say "None" for  balance & payment..
  Balance Monthly Payment
Rent or Mortgage
Credit Card
Auto Payments
Joint Account Holder  (if any, if not, please skip this section)
Name
Social Security Number
Driver's License Number
Driver's License State
Marital Status Important: Do not complete for individual unsecured credit.
Married
Unmarried (includes single, widowed and divorced)
Separated
Birth date (xx/xx/xxxx)
Home Address
City
State
Zip
Joint Applicant Employment Information
Work Phone Number
Employer name
Address
City
State
Zip
Position
Gross Monthly Pay
Submission Information
Comments or Questions:

Email Address:  

By checking this box, I/we acknowledge that we have read and understand the Credit Disclosure.

By submitting this application, I/We certify that I/We are 18 years of age or over, and that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize Central National Bank to investigate my/our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for, or for any other services offered.  This application does not constitute a contract for the extension of credit.