Loan Pre-Application

Loan Information

* Loan Amount

$ .00

* Loan Purpose

* Applying As

* Security Interest

i.e. collateral

Main Applicant

* First Name

Middle Initial

* Last Name

* Address Line 1

Address Line 2

* City

* State

* Zip Code

County

Email Address

* Phone

Please include area code

* Best time to call

Date of Birth

* At Current Residence Since

Month & year only

Residence Type

Rent Own Other

Monthly Housing Payment

$ .00

Employer Name

Employer Phone

Please include area code

Job Title

Job Start Date

Month & year only

Gross Annual Income

$ .00

Other Income

$ .00

Income from alimony, child support, or maintenance payments need not be revealed.

Joint Applicant

* First Name

Middle Initial

* Last Name

* Address Line 1

Address Line 2

* City

* State

* Zip Code

County

Email Address

* Phone

Please include area code

* Best time to call

Date of Birth

* At Current Residence Since

Month & year only

Residence Type

Rent Own Other

Monthly Housing Payment

$ .00

Employer Name

Employer Phone

Please include area code

Job Title

Job Start Date

Month & year only

Gross Annual Income

$ .00

Other Income

$ .00

Income from alimony, child support, or jointtenance payments need not be revealed.

Final Information

How did you learn of our online application?

Would you like to be notified about special offers from Stillman Bank?

Comments

Please read this notice carefully and print a copy for your records:

Stillman BancCorp, N.A. will not condition the approval of your loan application on your purchase of any type of insurance product from the bank.
If you choose to purchase an insurance product, you may do so from any insurance agency or broker.
Stillman BancCorp, N.A. offers credit life and accident health insurance through Pekin Insurance. However, you are not required to purchase this or any type of insurance in order to obtain a loan from us.
I/We have read this disclosure and understand its contents.
By submitting this pre-application, you are granting Stillman BancCorp NA the rights to obtain any additional information deemed necessary