Information

To be eligible for this account you must reside in one of the following North Carolina counties - Harnett, Wake, Johnston, Cumberland, Hoke, Moore, Lee, Chatham, Durham, Granville, Franklin, Nash, Wilson, Wayne or Sampson. Before proceeding, please confirm your eligibility below

Please select your county of residency :

By checking this box, I confirm that I am eligible for this account because I am a resident as I have indicated above:

Choose the branch location where you would like to meet with a lending representative:

How would you prefer to be contacted?:
Phone

Mail

Email

When is the best time to arrange an appointment?:
Morning

Lunchtime

Afternoon

Loan Amount Requested: $

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Applicant Information

First Name: Middle Name:

Last Name: Date of Birth:

Social Security Number: Driver's License Number:

State License Issue: Issue Date:

Expiration Date: Home or Cell Phone:

Daytime Phone: Email:

Number of Dependents: Age of Dependents:

Address Information

Current Residential Address (Not a P.O. Box): City:

State: Zip:

Use residential address for mailing address:
Yes

No
Mailing Address:

County of Residence: Number of Years & Months at Residence :

Previous Address (Complete IF less than 2 years at Current Residence): City:

State: Zip:

Employment Information

Current Employer: Address:

Phone: Position:

Length of Employment (Years & Months):

Income: Annual Gross Salary: $ OR Monthly Gross Salary: $

(Loan amount may require further income verification)

Previous Employer (Complete IF less than 2 years at Current Employer): Address:

Phone: Position:

Length of Employment (Years & Months):

Other Information

Nearest Relative Not Living With You: Relationship:

Address: Phone:

Home Ownership Status:
Own Home

Rent Home
Monthly Housing Payment:

Immigration Status :
U.S. Citizen

Perm. Resident of U.S.

Other
If Other, please specify immigration status:

Marital Status (DO NOT complete if this application is for an INDIVIDUAL application):
Married

Separated

Unmarried (including single, divorced

widowed)

Other Income: $ Frequency:

Source:

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Co-Applicant Information

First Name: Middle Name:

Last Name: Date of Birth:

Social Security Number: Driver's License Number:

State License Issue: Issue Date:

Expiration Date: Home or Cell Phone:

Daytime Phone: Email:

Number of Dependents: Age of Dependents:

Address Information

Current Residential Address (Not a P.O. Box): City:

State: Zip:

Use residential address for mailing address :
Yes

No
Mailing Address:

County of Residence: Number of Years & Months at Residence :

Previous Address (Complete IF less than 2 years at Current Residence): City:

State: Zip:

Employment Information

Current Employer: Address:

Phone: Position:

Length of Employment (Years & Months):

Income: Annual Gross: $ OR Monthly Gross: $

(Loan amount may require further income verification)

Previous Employer (Complete IF less than 2 years at Current Employer): Address:

Phone: Position:

Length of Employment (Years & Months):

Other Information

Nearest Relative Not Living With You: Relationship:

Address: Phone:

Home Ownership Status:
Own Home

Rent Home
Monthly Housing Payment: $

Immigration Status:
U.S. Citizen

Perm. Resident of U.S.

Other
If Other, please specify immigration status:

Marital Status:
Married

Separated

Unmarried (including single, divorced

widowed)

Other Income: $ Frequency:

Source:

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Asset Information: Complete with Assets Owned

Real Estate Owned-Property Address: Value: $ Subject to Lien:

Vehicle Owned-Description: Value: $ Subject to Lien:

Vehicle Owned-Description: Value: $ Subject to Lien:

Deposit Account-Bank Name: Balance: $

Deposit Account-Bank Name: Balance: $

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Additional Information

Are you a guarantor or co-maker of any leases, contracts, or debts?

Applicant:
Yes

No

Co-Applicant:
Yes

No

Are there any suits or judgments pending against you?

Applicant:
Yes

No

Co-Applicant:
Yes

No

Have you been declared bankrupt in the last 10 years?

Applicant:
Yes

No

Co-Applicant:
Yes

No

If you or co-applicant answered “yes” to any of the above questions, please explain in the space provided. :

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Certifications, Authorizations, & Signatures

You certify that everything you have stated in this Credit Application and on any other documents submitted to us are true and correct to the best of your knowledge. You understand that you must update the information contained in this Credit Application if either your financial condition materially changes or we make a request to you orally or in writing. You understand that we will retain this Credit Application whether or not it is approved.

You authorize us to request one or more consumer reports, to check and verify your credit and employment history, and to answer questions others may ask us about our credit experience with you.

You authorize us to contact you using any of the telephone numbers listed on this Credit Application or that you subsequently provide us in connection with your credit account - regardless whether the number we use is assigned to a paging service, cellular telephone service, specialized mobile radio service, other radio common carrier service or any other service for which you may be charged for the call. You further authorize us to contact you through the use of voice, text and email and through the use of prerecorded/artificial voice messages or an automatic dialing device.

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Electronic Signature

You further agree that you have signed this Credit Application with one or more electronic signatures. You intend your electronic signature to have the effect of your written ink signature. You viewed and read the entire Credit Application and notices before you signed it. You received a paper copy of this Credit Application after it was signed. You understand that this Credit Application is in the electronic form that we will keep. We may rely on, and enforce, this Credit Application in the electronic form or as a paper version of the electronic form.

Notice: It is a federal crime punishable by fine, imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Tittle 18, United States Code § 1001, et seq.

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Submit Application

First Federal Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.

I Agree: