Please note that by selecting this link, you will be directed to Lea County State Bank’s Application site.  Certain portions of this site are maintained by a third party that has been selected and approved by Lea County State Bank.



Non-Real Estate Loan Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

The items marked with (*) are required fields.

By selecting 'Submit' below, you agree to the terms and conditions listed in the disclosures.

View Disclosures

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General Information

Will you be applying for Individual or Joint Credit? *

(If Joint, the co-applicant section has the same required fields as the primary applicant.)

Marital Status: Complete marital status if this loan is for: a. Joint or secured credit, or b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)

Marital Status
*
*

Primary Applicant

*
*
*
*
*
*
*
*
*
*

Home Address

*
*
*
*

Time at Current Residence

Residence Type

Previous Address

Time at Previous Residence

Residence Type

Present Employer

Employment Status
*

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.

Previous Employer

Employment Status

CoApplicant

*
*
*
*
*
*

Home Address

*
*
*
*

Time at Current Residence

Residence Type

Previous Address

Time at Previous Residence

Residence Type

Present Employer

Employment Status

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.

Previous Employer

Employment Status

References

Nearest Relative Not Living With You

Debts Monthly Payments

List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan.

Additional Information

How would you prefer to be contacted?

Income verification is required; other information may be required.

I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)

IMPORTANT: Please only select "Submit" once. It may take a few moments for the confirmation to appear.