Individual Pre-Approval Form

If you are applying for individual credit, but are relying on income from alimony, child support, separate maintenance, or on the income or assets of another person as the basis for repayment of the credit requested, complete an Individual With Stipulations Pre-Approval form instead. Marine Trust's authorized lending area includes all communities within a 50 mile radius of Carthage.

I. Personal Information

First Name:
Last Name:		Suffix:
E-mail Address:
Address:

City:		State: Zip:
Telephone:
Date of Birth:		/ /
Social Security Number:		- -
Residence Type:
Time at Address:		Years Months
Mortgage Payment/Rent	$

II. Employment Information

Self Employed
Employer:
Occupation:
Position/Title:
Address:

City:		State: Zip:
Telephone:
Gross Monthly Income:	$

III. Nearest Relative or Friend Not Living With You

First Name:
Last Name:
Address:

City:	State: Zip:
Telephone:

Everything that I/we have stated in this application is correct to the best of my/our knowledge. I/we understand that you will retain this application whether or not it is approved. you are authorized to check my/our credit and my/our employment history and to answer questions about your credit experience with me/us.

APPLICANT SIGNATURE	___________________________________________________DATE________________
JOINT APPLICANT SIGNATURE	___________________________________________________DATE________________

flag As required by the
USA PATRIOT ACT
Important information about procedures for opening a new account

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 that identifies each person who opens an account.

What this means for you: When you open an account, 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.

Marine Bank & Trust thanks you for your understanding for joining us in securing a safer tomorrow.