Consumer Loan Application
  • You must be 18 years of age to apply for a loan.

  • For questions, call the Citizens Bank of Kansas Consumer Lending experts at (620) 532-5162.

  • Consumer Application

    Applicant #1
    Personal Information   Employment  
     
    * indicates required fields
    FULL NAME (First Middle Last) SOCIAL SECURITY #

    *   *

    *
    WORK PHONE #                                                          HOME PHONE #   EMAIL ADDRESS
                                 *
    DATE OF BIRTH                                       CITIZENSHIP YEARS OF SCHOOL COMPLETED
    *       
    MARITAL STATUS # OF DEPENDENTS         AGES
             
    HOME ADDRESS
    *  
    CITY                                                        STATE                                        ZIP
    * ,*   *
    YEARS AT PRESENT ADDRESS CURRENT RESIDENTIAL STATUS
     
    COMPLETE ADDITIONAL INFORMATION BY USING THE EMPLOYMENT TAB ABOVE. 
    Applicant #2 (click to complete)
    Loan Security/Collateral (click to complete)
    Asset Information (click to complete)
    Agreement and Submission

    I/We have applied for credit from the Lender. As part of the application process, the Lender and any potential investor or insurer of this loan may verify the information contained in my/our credit application and in other documents required in connection with this loan.                                                       

    I/We authorize you to provide to the Lender and to any potential investor or insurer of this loan, any and all information and documentation requested.  Such information may include, but is not limited to:  employment and income history, bank, money market and similar account balances; credit history; and copies of income tax returns.  The source of the information may come from, but is not limited to:  credit bureaus; banks and other depository institutions; current and former employers; federal or state records including State Employment Security Agency (SESA) records; or other sources as required.

    This authorization to access employment and income history from federal or state records including SESA records, for this transaction continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, allowed by law.

    Certification:  I/We certify that the information provided in this application is true and correct as of the date submitted by clicking "Submit Application" below. I/we acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentations which I/We have made on this application.