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Loan Application
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Consumer Loan Application

Please note: Applicant must be a resident of Kansas or Oklahoma and a U.S. Citizen, or permanent U.S. resident to qualify for this Internet offer.
Please provide all the requested information. When you have completed the form, press the "submit" button to send your application. For questions, you may contact us at:

Select the branch location most convenient for you




If you were assisted by a bank employee, please note the employee name in the text box below.
Fidelity Bank
100 E English
Wichita, KS 67201
Phone: 316-291-5626
Fax: 316-268-7436
Oklahoma Fidelity Bank
a Division of Fidelity Bank
2225 West Hefner Road
Oklahoma City, OK 73120
Phone: 1-800-658-1637 ext. 7771
Fax: 316-268-7436


IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account or takes out a loan. What this means for you: When you open an account with our bank, we will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.

CREDIT REQUESTED
Account Requested
Individual Credit      Joint Credit
We intend to apply for joint credit.

---------------------------
Applicant
 

---------------------------
Co-Applicant
 
Amount Requested: $
Purpose of Loan:
Type of loan requested:
Length of Loan Requested:

 

Primary Applicant

Last Name
First Name    Middle Initial
Social Security Number
Date of Birth (mm/dd/yyyy)       
Address
City
County
State      Zip   
Home Phone Number
Cell Phone Number
Rent      Own      Other
If renting, how long
Monthly rent payment
If owned, when did you buy your home (month/year) /
Purchase Price $
Current Value $
Current loan balance $
Monthly Payment $
Name of mortgage company
If you have lived at your current address less than two years, please provide your previous home address:
Address
City
State      Zip   
Email Address
Employer or Business:
Business Phone Number    Ext.
Job Start Date (month/year) / Year
*Gross Income
*Income verification is required.
$      Hourly     Monthly     Annually
Job Title
If less than two years at current job, please provide previous employment:
Previous employment
Length of employment
**Other Income Hourly     Monthly     Annually
Source of Income
**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.
Primary Financial Institution
Marital Status: Complete if applying for secured or joint credit:
Married      Separated      Unmarried (including single, divorced, and widowed)
Do you pay child support or Alimony: Yes       No
Monthly payment amount: $
Have you been declared bankrupt in the last 10 years: Yes       No
Are you a co-maker, endorser or guarantor on any loan or contract? Yes       No
If yes, for whom:
If yes, to whom:
Are there unsatisfied judgements against you? Yes       No
If yes, for whom:
If yes, to whom:
Name of nearest relative not living with you
Name
Address
Phone Number
DEBT INFORMATION:
List all debts including Creditor, Current Balance, and Monthly Payment (for example auto loans, RV loans, credit cards, second mortgage, medical, student loans, etc.) Please use a separate line for each account.
Creditor Monthly Payment Current Balance

 

Joint Applicant (if applicable)

Last Name
First Name    Middle Initial
Social Security Number
Date of Birth (mm/dd/yyyy)       
Complete address section if different than Primary Applicant.
Address
City
State      Zip   
Home Phone Number
Cell Phone Number
Rent      Own      Other
If renting, how long
Monthly rent payment
If owned, when did you buy your home (month/year) /
Purchase Price $
Current Value $
Current loan balance $
Monthly Payment $
Name of mortgage company
If you have lived at your current address less than two years, please provide your previous home address:
Address
City
State      Zip   
Email Address
Employer or Business:
Business Phone Number    Ext.
Job Start Date (month/year) / Year
*Gross Income
*Income verification is required.
$      Hourly     Monthly     Annually
Job Title
If less than two years at current job, please provide previous employment:
Previous employment
Length of employment
**Other Income
Source of Income
**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.
Primary Financial Institution
Marital Status: Complete if applying for secured or joint credit:
Married      Separated      Unmarried (including single, divorced, and widowed)
Do you pay child support or Alimony: Yes       No
Monthly payment amount: $
Have you been declared bankrupt in the last 10 years: Yes       No
Are you a co-maker, endorser or guarantor on any loan or contract? Yes       No
If yes, for whom:
If yes, to whom:
Are there unsatisfied judgements against you? Yes       No
If yes, for whom:
If yes, to whom:
Name of nearest relative not living with you
Name
Address
Phone Number
DEBT INFORMATION:
Complete if different than Primary Applicant

List all debts including Creditor, Current Balance, and Monthly Payment (for example auto loans, RV loans, credit cards, second mortgage, medical, student loans, etc.) Please use a separate line for each account.

Creditor Monthly Payment Current Balance

*THIS INFORMATION IS ONLY REQUIRED FOR HOME IMPROVEMENT,

HOME PURCHASE, OR REFINANCE.

Does not apply to my loan type Does apply to my loan type
   
Do not fill out this information if it does not apply to your loan type. Please proceed to the bottom of the application to complete the submission process.
If this information does apply to your loan type, please read:

The following information is requested by the federal government for certain types of loans related to dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below. (Lender must review the requested material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
Applicant:    I do not wish to furnish the following information
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian or Alaska Native Native Hawaiian or Other Pacific Islander
Asian White
Black or African American
Sex:
Male Female
 
Co-Applicant:    I do not wish to furnish the following information
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian or Alaska Native Native Hawaiian or Other Pacific Islander
Asian White
Black or African American
Sex:
Male Female

By completing and submitting this loan application, you certify that the information in it is correct and you authorize Fidelity Bank to verify such information, to obtain credit reports, to verify any other credit references, and to make such other investigations as Fidelity Bank deems appropriate. You agree to promptly notify Fidelity Bank of any adverse change in your financial condition. This application does not constitute a contract for the extension of credit. Sec. 1014, Title 13, U.S. Code, makes it a Federal Crime to knowingly make a false statement on this application. IMPORTANT INSURANCE DISCLOSURE: In connection with your loan application, the Bank may solicit, offer, or sell an insurance product to you. The Bank cannot, as a condition of extending credit to you: (i) require that you purchase an insurance product from the Bank, or (ii) require your agreement not to obtain, or prohibit you from obtaining, an insurance product from an unaffiliated entity.

Any comments or questions you may have for us?


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