© 2010 The Forms Group, All Rights Reserved


Internet Loan Application

Privacy Policy: Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Applicants must reside in a Marland, Virginia, or Washington D.C.

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: To help the government fight the funding of terrorism and money laundering activities, Federal law 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.

Security Notice: You should ONLY fill out this loan application on-line if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now. This form is NOT cached (saved in your computer's memory) when you QUIT your browser.

Instructions:

1. Print this loan application and gather the information you'll need.

2. Fill-out the application ON-LINE and click "Submit Application" or FAX it to 410.356.2649.

3. QUIT your browser and restart it again after using this form.

This loan application is for personal loans only and is NOT intended for commercial use. A valid social security number is required to apply. Please review and gather the information you will need before completing this form.



Loan Request

Type of Application:
Individual Applicant Joint Applicant

Type of Loan:
Auto Home Equity
Personal Secured Personal Unsecured

Amount Requested:

If Personal Loan, indicate purpose:

Desired Monthly Payment , or Term Requested:
24 mos. 36 mos. 48 mos. 60 mos. Other

Tell Us About Yourself


First Name

Middle Initial

Last Name

Date of Birth

Social Security No.

No. of Dependents

Driver's License No.

Driver's License State

Your E-mail Address

Home Phone

Best Time To Call

Work Phone

Are there any unsatisfied Judgments against you? Yes No

Have you been declared bankrupt in the last 7 years? Yes No

Your Residence


Your Primary Residence:
Own with Mortgage Own Clear Rent Other

Present Street Address

City

State

Zip

Years At Present Address

Your Monthly Rent or Mortgage Payment

Years At Previous Address

Your Previous Address

Home Information

Collateral Property Address
(If different from above)


Date Purchased

Current Mortgage Holder

Mortgage Holder Phone

Purchase Price

Market Value

Mortgage Balance


Your Employment

Employed Self-Employed Retired Unemployed Student

Your Present Employer

Phone

Street Address

City

State

Zip

Years There

Your Positon

Gross Monthly Salary

You do not have to list alimony, child support or separate maintenance income unless you want
us to consider it for the purposes of granting and repayment of this credit request.

Other Monthly Income

Source of Other Income

Previous Employer
(if less than 3 years at current employer)

Years at Previous Employer

Previous Employer
Street Address


City


State


Zip

Additional Information

Your Checking Account Number

Institution Name

Your Savings Account No.

Institution Name

Name of
Creditor

Approximate
Balance

Monthly
Payment

Collateral,
if any


Total Amount of "Other" Monthly Payments not listed above:

Assets

Value

Title Held Name

Joint Applicant


First Name

Middle Initial

Last Name

Date of Birth

Social Security No.

No. of Dependents

Driver's License No.

Driver's License State

Your E-mail Address

Home Phone

Best Time To Call

Work Phone

This Section for AUTO LOAN Applicants

Year of Vehicle

Make

Model

Purchase Price

Down Payment

Finance Amount

Trade-In Yes No

Purchasing from Dealer Yes No

Dealer Name

This Section for HOME EQUITY LOAN Applicants

Information For Government Monitoring Purposes

This section to be completed only for loans subject to reporting under the Home Mortgage Disclosure Act (HMDA).

HMDA loans are loans made for the following purposes: Home Purchase (secured), Home Improvement (secured or unsecured), or refinance of a loan secured by a 1-4 residential dwelling (regardless of purpose).

The following information is requested by the Federal government for certain types of loans related to a dwelling, in order to monitor the Lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it.

If you choose to furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this Lender is required to note the information on the basis of visual observation or surname.

If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)

Applicant:
I do not wish to furnish this information.

Ethnicity:
Hispanic or Latino
Not Hispanic or Latino

Race or National Origin:
American Indian, Alaskan Native
Asian
Native Hawaiian or other Pacific Islander
White
Black or African American

Sex:
Female Male
Co-Applicant:
I do not wish to furnish this information.

Ethnicity:
Hispanic or Latino
Not Hispanic or Latino

Race or National Origin:
American Indian, Alaskan Native
Asian
Native Hawaiian or other Pacific Islander
White
Black or African American

Sex:
Female Male

Applicant(s) Statement
I/We have completed this request for credit in consideration of Regal Bank & Trust lending to me and/or others upon my guarantee. I/We certify that all information contained herein is accurate and complete to the best of my knowledge.

I/We authorize Regal Bank & Trust to retain property of this application, to rely on the foregoing, to check and verify my credit, employment and salary history, to secure follow up credit reports concerning my credit worthiness and to exchange information about my account with proper persons, creditors and credit bureaus.

I authorize my employer (present and future), bank and other references listed above to release and/or verify information to Regal Bank & Trust at any time. I acknowledge that this application is subject to approval of credit and acceptance by Regal Bank & Trust . Should my request for credit and subsequent loan be approved, I agree to give Regal Bank & Trust written notice immediately upon change of my name, address, employment or any other pertinent information contained herein.


I/We AGREE with the above statement



For more information about Regal Bank & Trust products and services

Phone:
443.334.4729

Fax:
410.356.2649