It has been brought to our attention that fraudsters are actively contacting bank customers and claiming that the customer's card has been deactivated. The fraudster then requests that the customer enter their information to reactivate the card. Please be aware that this is a Phishing Scam and Citizens State Bank will never ask you to key in or provide your card information in such a manner. Disregard the call and DO NOT provide your personal or financial information.

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Consumer Loan Application

To help the government fight the funding of terrorism or money laundering activities, U.S. Federal Law requires financial institutions to obtain, verify, and record information that identifies each person who opens an account. 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 for your driver’s license or other identifying information.

 

General Loan Information

** - includes Single, Divorced, or Widowed *Do you currently have a banking relationship with us?

Monthly Payment Obligations

Personal Information

Contact Information

Identification Information

Employment Information

Employment Status:





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.

Employment History

I Agree:

  • That everything I have stated in this loan inquiry is correct.
  • That the Lender may keep this inquiry information whether or not it is approved.
  • I authorize Lender to check my credit and employment history and to answer questions others may ask Lender about my credit record with Lender.
  • That I must update credit information at Lender’s request if my financial condition changes.