FDIC-Insured - Backed by the full faith and credit of the U.S. Government
F&M Bank

Personal Loan Application











Farmers & Merchants Bank makes loans without regard to race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to contract). Please feel free to call us at 540-896-8941 or visit one our local branches. This application is for personal loans not secured by real estate.

* Required

Check Appropriate Option *
Applicant
Address *
Is mailing address the same as above? *
Mailing Address
Home Status *
Previous Address (if less than 2 years)
Employment Info
Current Employer *
Self Employed *
Address *
Previous Employer
Self Employed
Address
Co-Applicant
Address
Is mailing address the same as above?
Mailing Address
Previous Address (if less than 2 years)
Employment Info
Current Employer
Self Employed
Address
Previous Employer
Self Employed
Address

*Notice: Alimony, child support, or separate maintenance income need not be revealed if an Applicant does not choose to have it considered as a basis for repaying this loan.

Liabilities

Current obligations including banks, finance companies, department stores and credit cards. Indicate debts of "Applicant" and debts of "Co-applicant". Indicate debts on which both are jointly obligated with "Joint".

First Mortgage
Second Mortgage
Auto 1
Auto 2
Other Debt 1
Other Debt 2
Are you a Guarantor or Co-Signer for anyone?
Schedule of Other Real Estate Owned
Property 1
Address
Property 2
Address
Property 3
Address
Miscellaneous Information

Indicate "Applicant", "Co-applicant", or "Joint" as appropriate.

Applicant's Nearest Relative
Co-Applicant's Nearest Relative
Has either applicant ever been party to any suits, judgments, garnishments, bankruptcy, or other legal proceedings?
How did you hear about us? *

You may check my credit and employment history and answer questions about your credit experience with me. Everything I have stated in this application is correct and accurate to the best of my knowledge. Under penalties of perjury, I certify that I have provided my correct Social Security Number (Taxpayer Identification Number), and that I am not subject to Internal Revenue Service backup withholding. Name and Taxpayer Identification Number of Applicant will be used for IRS information reporting, if applicable.

Thank you for your application!

Someone will be in touch with you soon.




























iOS and Android Users

Download the F&M Bank app on your mobile device.