Consumer Loan Application $

Consumer Loan Application I am applying for a (choose all that apply): Executive Line of Credit Requested Loan Amount Personal Line of Credit Home Equity Line of Credit Personal Loan Overdraft Protection Other Type of Application Individual (own income or assets) Individual (own income or assets plus income or assets from other sources) Joint – We intend to apply for joint credit (please initial) Applicant Joint Applicant $ Is this an increase to an existing Line of Credit? yes no Loan Purpose Automatic Payment Authorization (Optional) I/we authorize Pacific Rim Bank to withdraw the minimum payment(s) due from (check one): Pacific Rim Bank Checking Account Number: Pacific Rim Bank Savings Account Number: Checking Account at Other Financial Institution: Financial Institution Name: Routing Number: Account Number: I/we agree that this authorization will not be cancelled until the loan and/or line is paid in full or I/we revoke this authorization in writing. Please attach a voided check from the account listed above Primary Applicant GENERAL INFORMATION Last Name Taxpayer ID Number (SSN/TIN) Home Address City Driver’s License Number Email Address Previous Address (if less than 2 years at current address) City State Zip Code First Name MI Date of Birth (mm/dd/yyyy) Home Phone Number Last Name Taxpayer ID Number (SSN/TIN) Home Address Own Rent Expiration Date (mm/dd/yyyy) Preferred Method of Contact Email State Phone Zip Code Driver’s License Number Email Address City Joint Applicant First Name MI Date of Birth (mm/dd/yyyy) Home Phone Number ( ) State Zip Code ( ) Own Rent No. of Years There No. of Years There Expiration Date (mm/dd/yyyy) Preferred Method of Contact Email Phone Zip Code Previous Address (if less than 2 years at current address) City State EMPLOYMENT INFORMATION Employer (If self-employed or retired, attach income tax returns for the past two years) Employer Address Business Industry Employer Phone No. of Years Job Title/Military Rank City State Zip Code Employer (If self-employed or retired, attach income tax returns for the past two years) Employer Address Business Industry Employer Phone No. of Years Job Title/Military Rank City State Zip Code ( ) ( ) Previous Employer (If less than two years) Previous Employer Address Previous Employer Phone City No. of Years State Zip Code Previous Employer (If less than two years) Previous Employer Address Previous Employer Phone City No. of Years State Zip Code Job Title/Military Rank Job Title/Military Rank ( ) Monthly Other Income* Source of Other Income ( ) Monthly Other Income* Source of Other Income INCOME INFORMATION Monthly Gross Income Monthly Gross Income $ $ $ OTHER INFORMATION Yes No $ * Alimony or child support or separate maintenance income are optional information and need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Yes Have you ever filed for bankruptcy within the past 10 years? Are there any outstanding judgments or liens against you? Are you a guarantor/co-signer on any leases, contracts, or loans? If you have answered “Yes” to any of the above questions, please attach an explanation of the circumstances or situation. No Have you ever filed for bankruptcy within the past 10 years? Are there any outstanding judgments or liens against you? Are you a guarantor/co-signer on any leases, contracts, or loans? If you have answered “Yes” to any of the above questions, please attach an explanation of the circumstances or situation. 05-2008 FINANCIAL INFORMATION ASSETS Bank or Financial Institution Name Bank or Financial Institution Name Bank or Financial Institution Name Year Home Purchased Primary Car Year/Make Checking Account Number Savings Account Number Other Account Number Original Purchase Price Model Current Balance Mark the checkbox below if the liability listed is to be paid off with the proceeds of this loan Primary Residence Mortgage Institution Name Landlord Name Loans Payable to Pacific Rim Bank Loans Payable to Other Banks Auto Loan Other Mortgages (Complete Section Below) Monthly Payment Current Balance LIABILITIES $ Current Balance $ Monthly Rent $ Current Balance $ Current Balance $ Monthly Payment $ Current Balance $ Present Value $ Monthly Payment $ Current Balance $ Present Value $ Monthly Payment $ Current Balance $ Other Real Estate (Complete Other Real Estate Section Below) Present Value $ Monthly Payment $ Current Balance Total Other Real Estate Marketable Stocks/Bonds (Issuer, Type, Number of Shares) Other Assets (List Below) $ Present Value Total Other Mortgages Credit Cards (List Below) $ Monthly Payment $ Current Balance $ Present Value $ Monthly Payment $ Current Balance $ Present Value Other Liabilities (e.g. Child support, Alimony, etc.) $ Monthly Payment $ Current Balance $ Present Value $ Monthly Payment $ Current Balance $ TOTAL ASSETS $ OTHER REAL ESTATE Property Address Mortgage Company Year Acquired Purchase Price Present Value $ $ TOTAL LIABILITIES $ Current Mortgage Balance Monthly Payment Monthly Rental Income $ $ $ $ $ $ $ $ Present Value $ $ $ $ $ $ $ $ $ $ $ $ $ $ Monthly Rental Income Current Mortgage Balance Monthly Payment TOTALS: $ $ By signing and submitting this form, I/we warrant the truth of the information contained in this application and that all statements made in this application are made for the purpose of obtaining the loan applied for. I/we warrant that the financial obligations disclosed in this application and in support of this application are complete and that I/we have no other outstanding financial obligations of any kind, including any guarantor or cosigner liability. Pacific Rim Bank, its agents, successors, and assigns (collectively the “Bank”) will rely on the information contained in this application and I/we have a continuing obligation to amend and supplement the information provided in this application if any of the material facts I/we represented should change before closing. If I/we have left any spaces in this application blank, the Bank may assume the information requested is adverse. I/we authorize the Bank to investigate and verify all information I/we provided to the Bank. I/we understand that it is my/our sole and exclusive responsibility to determine all the tax effects of the loan and acknowledge that the Bank has not provided any tax advice to me. The Bank can give information about my/our loan to credit reporting agencies and others who may properly receive that information. If the Bank approves this application and the Bank is required to report the amount of interest paid on the loan to the Internal Revenue Service, I/we understand that the Bank will report using the Social Security Number (tax identification number) shown above. I/we understand that if the social Security Number is incorrect that I/we may be subject to Internal Revenue Service penalties. I/we understand the Bank will keep this application whether or not my/our credit request is approved. Certification: I/we certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my understanding that any intentional or negligent misrepresentations 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 Bank, insurers, and any other person who may suffer any loss due to reliance upon any misrepresentation I/we made in this application or in any other manner. 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 to you: When you open an account, we will ask you 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. CUSTOMER CONSENT, ACKNOWLEDGEMENT, AND CERTIFICATION X Primary Applicant Signature Date X Joint Applicant Signature Date Print Form 05-2008