Native 360 Pre-Application Form - Encryption Test

Credit Requested
Account Requested*
- Individual
- Joint
Applicant Initials*

I intend to apply for credit.
Co-Applicant Initials*

I/we intend to apply for joint credit.
Amount Requested*
Preferred Number of Payments*
Preferred Payment Amount*
Preferred Payment Date*
Specific Purpose of Loan*
Collateral Offered*

Enter one item per line. Click the plus sign to add more lines.
Applicant Information
Complete the Applicant Information section for the first Applicant. Mark the appropriate box to indicate whether the Applicant is applying as a Borrower, Cosigner, Guarantor, Granter (of collateral), or Other for different capacity. If the Applicant is married, he or she may apply for individual credit.
Applicant's Role*
- Borrower
- Cosigner
- Guarantor
- Grantor
Applicant's Full Name*
First M.I. Last
Former Names and Aliases

Enter one per line. Click the plus sign to add more lines.
Applicant Email Address*
Home Phone*
Date of Birth*
Social Security Number*
Driver's License Number*
Ages of Dependents

Enter one per line. Click the plus sign to add more lines.
Years of Education*
Years in Current Profession*
Address Information
Home Address*
Street Address Address Line 2 City State ZIP Code

If rural, include Road and Box No.
Resident Since*
Resident Type
- Owner
- Renter
Different Mailing Address?
- Yes
- No
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Previous Home Address
Street Address Address Line 2 City State ZIP Code

If rural, include Road and Box No.
From*
To*
Employment Information
Applicant's Employer*

If self-employed, enter Name and Nature of Business
Business Address*
Street Address Address Line 2 City State ZIP Code
Type of Business*
Supervisor*
Phone Number*
Title/Position*
Since*
Salary*
Amount Per
Enter salary amount per period (week, month, year, etc.)
Second Employer?
- Yes
- No
Hidden
Second Employer (Hidden)
Applicant's Second Employer*

If self-employed, enter Name and Nature of Business
Business Address*
Street Address Address Line 2 City State ZIP Code
Type of Business*
Supervisor*
Phone Number*
Title/Position*
Since*
Salary*
Amount Per
Enter salary amount per period (week, month, year, etc.)
Applicant's Personal References
List References
Name Address Phone Relationship

Please list three personal references. Click the plus icon to add another reference.
Co-Applicant Information
1. If you are applying for joint credit or will be permitted to use the account, complete the Co-Applicant Information section as a Borrower.
2. If the Applicant is applying for individual credit, but relying on income from alimony, child support, or separate maintenance or on. the income or assets of another person as the basis for repayment of the credit requested, complete the Co-Applicant Information section, to the extent possible, providing information about the person on whose alimony, support, or maintenance payments or income or assets the Applicant is relying.
3. lf the Applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested, complete the Co-Applicant Information section with regard to the Applicant's spouse.
Co-Applicant's Role*
- Borrower
- Cosigner
- Guarantor
- Grantor
Co-Applicant's Full Name*
First M.I. Last
Former Names and Aliases

Enter one per line. Click the plus sign to add more lines.
Home Phone*
Co-Applicant Email Address*
Date of Birth*
Social Security Number*
Driver's License Number*
Ages of Dependents

Enter one per line. Click the plus sign to add more lines.
Years of Education*
Years in Current Profession*
Co-Applicant Address Information
Home Address*
Street Address Address Line 2 City State ZIP Code

If rural, include Road and Box No.
Resident Since*
Resident Type
- Owner
- Renter
Different Mailing Address?
- Yes
- No
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Previous Home Address
Street Address Address Line 2 City State ZIP Code

If rural, include Road and Box No.
From
To
Co-Applicant Employment Information
Co-Applicant's Employer*

If self-employed, enter Name and Nature of Business
Business Address*
Street Address Address Line 2 City State ZIP Code
Type of Business*
Supervisor*
Phone Number*
Title/Position*
Since*
Salary*
Amount Per
Enter salary amount per period (week, month, year, etc.)
Second Employer?
- Yes
- No
Hidden
Co-Applicant's Second Employer (Hidden)
Co-Applicant's Second Employer*

If self-employed, enter Name and Nature of Business
Business Address*
Street Address Address Line 2 City State ZIP Code
Type of Business*
Supervisor*
Phone Number*
Title/Position*
Since*
Salary*
Amount Per
Enter salary amount per period (week, month, year, etc.)
Co-Applicant's Personal References
List References
Name Address Phone Relationship

Please list three personal references. Click the plus icon to add another reference.
Questions
For Applicant
- Are there any outstanding judgments against you?*
  - Yes
  - No
- Explanation*
- Have you declared bankruptcy in the last 7 years?*
  - Yes
  - No
- Explanation*
- Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?*
  - Yes
  - No
- Explanation*
- Are you party to a lawsuit?*
  - Yes
  - No
- Explanation*
- Are you obligated on any loan resulting in judgment, foreclosure or title transfer?*
  - Yes
  - No
- Explanation*
- Are you delinquent/in default on any Federal debt, financial obligation, bond, or loan guarantee?*
  - Yes
  - No
- Explanation*
- Are you obligated to pay alimony, child support, or separate maintenance?*
  - Yes
  - No
- Explanation*
- Is any part of the down payment borrowed?*
  - Yes
  - No
- Explanation*
- Are you a co-maker or an endorser on a loan?*
  - Yes
  - No
- Explanation*
- Have you ever had merchandise repossessed?*
  - Yes
  - No
- Explanation*
- Have you ever been denied credit with this lender?*
  - Yes
  - No
- Explanation*
- Are you a U.S. citizen?*
  - Yes
  - No
- If no, are you a resident alien?*
  - Yes
  - No
- If no, are you a non-resident alien?*
  - Yes
  - No
For Co-Applicant
- Are there any outstanding judgments against you?*
  - Yes
  - No
- Explanation*
- Have you declared bankruptcy in the last 7 years?*
  - Yes
  - No
- Explanation*
- Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?*
  - Yes
  - No
- Explanation*
- Are you party to a lawsuit?*
  - Yes
  - No
- Explanation*
- Are you obligated on any loan resulting in judgment, foreclosure or title transfer?*
  - Yes
  - No
- Explanation*
- Are you delinquent/in default on any Federal debt, financial obligation, bond, or loan guarantee?*
  - Yes
  - No
- Explanation*
- Are you obligated to pay alimony, child support, or separate maintenance?*
  - Yes
  - No
- Explanation*
- Is any part of the down payment borrowed?*
  - Yes
  - No
- Explanation*
- Are you a co-maker or an endorser on a loan?*
  - Yes
  - No
- Explanation*
- Have you ever had merchandise repossessed?*
  - Yes
  - No
- Explanation*
- Have you ever been denied credit with this lender?*
  - Yes
  - No
- Explanation*
- Are you a U.S. citizen?*
  - Yes
  - No
- If no, are you a resident alien?*
  - Yes
  - No
- If no, are you a non-resident alien?*
  - Yes
  - No
Schedule of Other Income
NOTICE: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Alimony, child support, separate maintenance received under
- Court Order
- Written Agreement
- Oral Understanding
- Other

List Other Income Sources

Income Type	Amount	Actions

There are no Income Sources.

File Upload
File Upload
Please upload PDF documents as directed by your loan officer, including pay stubs for the last two pay periods. We require personal tax returns for the last two years. If this is a loan for your business, we require the last two years of business taxes and personal taxes. If your loan is approved, we require a cancelled check to setup electronic loan payments from your checking account.
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, xls, xlsx, csv, pub, Max. file size: 512 MB.
Applicant Signature(s)
Consent to Credit Report*
I agree that Native360 is authorized to run a credit report upon reciept of this application.
Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose.
Consent Statment*
I agree to the conditions listed below.
I/We hereby apply for the loan or credit, as described in this application. I/We certify that I/We made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/We did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell any part of the loan. I/We further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit, or loan.
Applicant Signature*
Co-Applicant Signature*
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Credit Requested

Applicant Information

Address Information

Employment Information

Second Employer (Hidden)

Applicant's Personal References

Co-Applicant Information

Co-Applicant Address Information

Co-Applicant Employment Information

Co-Applicant's Second Employer (Hidden)

Co-Applicant's Personal References

Questions

For Applicant

For Co-Applicant

Schedule of Other Income

File Upload

Applicant Signature(s)

Latest News

Contact Us

Grand Island, Nebraska

Pete Upton, Executive Director

Name	Address	Phone	Relationship

Name	Address	Phone	Relationship

Native 360 Pre-Application Form – Encryption Test

Credit Requested

Applicant Information

Address Information

Employment Information

Second Employer (Hidden)

Applicant's Personal References

Co-Applicant Information

Co-Applicant Address Information

Co-Applicant Employment Information

Co-Applicant's Second Employer (Hidden)

Co-Applicant's Personal References

Questions

For Applicant

For Co-Applicant

Schedule of Other Income

File Upload

Applicant Signature(s)

Latest News

Contact Us

Grand Island, Nebraska

Pete Upton, Executive Director