Suite B Neosho, MO 64850
pking@swcsecu.us
Tuesday - Friday
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Full Name
Social Security Number
Date Of Birth
Address
City, State Zip
HomePhone
Cell Phone
Email
School Email
Employer
Employer’s Address
Employer’s Phone
Number Of Years Of Service
Position
School
Supervisor
Salary
Salary Weekly YES
Salary Bi-Monthly YES
Salary Monthly YES
Salary Annual YES
Salary Other
Child Support
Former Employer If Current Less Than 4 Years
Former Employer Address
Spouse Name
Souse Social Security Number
Souse Date Of Birth
Spouse Employer
Spouse Employer Address
Spouse Employer Phone
Spouse Employed Number Of Years
Spouse Employed Position
Spouse Employer Supervisor
Spouse Gross Salary
Souse Salary Weekly YES
Spouse Salary Bi-Monthly YES
Spouse Salary Monthly YES
Spouse Salary Annual YES
Would You Like A Signature Loan YES
Do You Have Collateral YES
If so, Collateral Type
Would You Like A Share Secured Loan YES
Loan Share Secured Amount
Do You Rent A Home YES
Do You Own Your Home YES
How Long Have You Lived In Your Home In Years
Your Home Value
Landlord
Landlord Phone
Home Payment or Rent Amount
Is Your Home Payments Current Yes YES No YES
Mortgage Balance
Mortgage Financier
Name Of Relative Not Living With You
Relative Phone
Relative Relation
Relative Address
Have You Filed For Bankruptcy Yes YES No YES
Date Of Bankruptcy
Are There Any Legal Proceedings Against You Yes YES No YES
If So, Please Explain
Personal Reference
Personal Reference Address
Personal Reference Phone
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