Apply for an Installment Loan

Overview

Purpose of the Loan

Amount Requested

Marital Status

You May Apply for Separate or Joint Credit

Separate Credit (complete Application Section I) Complete Section II with information about your spouse only if you are a married Wisconsin resident.

Joint Credit with Spouse Complete Section I and Section II.

Joint Credit with someone who is not your spouse. Each joint applicant must complete a separate application as if applying for separate credit and submit them together, including completing Section II if you are a married Wisconsin resident.

Joint Credit Individual's name

Please read and agree to the following procedures 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 the identifies each person who obtains credit. What this means for you: when you obtain credit, 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.

Applicant - For secured credit or Wisconsin residents only.

Co-Applicant - For secured credit or Wisconsin residents only.

Applicant Information Section I

First Name

MI

Last Name

Email Address

Phone Number

Preferred Method of Contact Email Phone

Address Line 1

Address Line 2

City

State

ZIP

Previous Address (if current address is less than 2 years)

Do you Own or Rent?

If you rent, what is your monthly payment?

Years at Residence

Current Value (if you own)

Social Security Number

Date of Birth

Employer Name

Years with Employer

Job Title

Work Phone

Annual Income

Previous Employer (if less than 2 years with current employer)

Authorization to Release Information

You need not list income from alimony, child support or separate maintenance unless you wish it considered for the purpose of repaying this obligation.

A married Wisconsin resident applying for credit in his/her own name must complete the required spousal information in the co-applicant section.

Co-Applicant Joint Credit Section II

Please Check One

Co-Applicant Joint Credit

Spouse Non Applicant

Co-Applicant Information

First Name

MI

Last Name

Email Address

Phone Number

Address Line 1

Address Line 2

City

State

ZIP

Previous Address (if current address is less than 2 years)

Social Security Number

Date of Birth

Employer Name

Years with Employer

Job Title

Work Phone

Annual Income

Previous Employer (if less than 2 years with current employer)

Authorization to Release Information

You need not list income from alimony, child support or separate maintenance unless you wish it considered for the purpose of repaying this obligation.

A married Wisconsin resident applying for credit in his/her own name must complete the required spousal information in the co-applicant section.

Debts & Obligations

Mortgages

1st Mortgage Lender Name

Address Line 1

Address Line 2

City

State

ZIP

Monthly Payment

Interest Rate

Unpaid Balance

2nd Mortgage Lender Name

Address Line 1

Address Line 2

City

State

ZIP

Monthly Payment

Interest Rate

Unpaid Balance

Car Loan

Auto Lender Name

Monthly Payment

Unpaid Balance

Credit Cards & Personal Loans

Name of Credit Card / Lender

Minimum Monthly Payment

Unpaid Balance

Name of Credit Card / Lender

Minimum Monthly Payment

Unpaid Balance

Name of Credit Card / Lender

Minimum Monthly Payment

Unpaid Balance

Additional Information (such as the name of a banker you are currently working with)

Authorizations

Authorization to Release Information

I authorize Port Washington State Bank to obtain my/our credit report for the purpose of determining credit worthiness. The information that is obtained is strictly confidential. A photocopy or fax of this authorization may be deemed to be the equivalent of the original.

For Married Applicant Applying for Separate Credit

The credit being applied for, if granted, will be incurred in the interest of my marriage or family.

NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under s788.58, Wis Stats, or court decree under s788.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

Please Select Your Closest PWSB Branch:

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Authorization to Release Information

Co-Applicant Information

Authorization to Release Information

Mortgages

Car Loan

Credit Cards & Personal Loans