Thank you for your interest in applying for a Consumer Loan with FCNB Bank! Please complete the following form with as much information as possible. Once we receive your submission, a Loan Officer will contact you to finalize the application process.

IMPORTANT INFORMATION ABOUT INSURANCE SALES PRACTICES

Please read this carefully.

If you choose to purchase insurance related to this loan, you may do so from any insurance provider. FCNB Bank will not condition the approval of your loan application on your purchase of any type of insurance product from FCNB Bank or any of its affiliates.

The insurance product you may apply for is not a deposit or obligation of, or guarantee by FCNB Bank or its affiliate and is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, FCNB Bank, or an affiliate of FCNB Bank.

When you sign below, you state that you have read this disclosure, and understand its contents, as evidenced by your consent below. A copy of this disclosure has been presented to you at the time of application and may be provided to you again at closing. You understand that this acknowledgement will be made a permanent part of your loan application.

JOINT CREDIT NOTICE (if applicable)

If you are applying for joint credit, please sign below to acknowledge your intention. This includes all coborrower(s}, co-signer(s) and/or guarantor(s) for the loan.

CONSUMER LOAN APPLICATION

Credit Requested Is(Required)

Collateral Secured Loan

Personal Unsecured Loan

Account Requested(Required)

Individual

Joint

Amount Requested(Required)

Description of Collateral Offered(Required)

Purpose of Credit Request(Required)

If the Applicant is married, he or she may apply for individual credit. For Marital Status, check one if a) you are applying for secured credit; b) you reside in a community property state; or c) you are relying on property in a community property state as a basis for repayment of the credit requested.

APPLICANT INFORMATION

Applicant

Applicant Role(Required)

Borrower

Co-Signer

Guarantor

Applicant Name(Required)

(include Jr. or Sr. if applicable)

First Middle Last

Social Security Number(Required)

Phone Number(Required)

DOB(Required)

Email Address(Required)

Relationship Status(Required)

Married

Separated

Unmarried (include single, divorced, widowed)

Number of Dependents and Ages

(not listed by Co-Applicant)

Citizenship(Required)

U.S. Citizen

Permanent Resident Alien

Non-Resident Alien

Present Address(Required)

Street Address Address Line 2 City State ZIP Code

Since

Mailing Address

If different from Present Address

Street Address Address Line 2 City State ZIP Code

If residing at present address for less than two years, complete the following:

Former Address

Street Address Address Line 2 City State ZIP Code

From

Co-Applicant

Applicant Role

Borrower

Co-Signer

Guarantor

Co-Applicant Name

(include Jr. or Sr. if applicable)

First Middle Last

Social Security Number

Phone Number

DOB

Email Address

Relationship Status

Married

Separated

Unmarried (include single, divorced, widowed)

Number of Dependents and Ages

(not listed by Co-Applicant)

Citizenship

U.S. Citizen

Permanent Resident Alien

Non-Resident Alien

Present Address

Street Address Address Line 2 City State ZIP Code

Since

Mailing Address, if different from Present Address

Street Address Address Line 2 City State ZIP Code

If residing at present address for less than two years, complete the following:

Former Address

Street Address Address Line 2 City State ZIP Code

From

EMPLOYMENT/INCOME INFORMATION

Applicant

Name of Employer #1(Required)

Address of Employer

Street Address Address Line 2 City State ZIP Code

Self Employed

Years on this job(Required)

Status(Required)

Full Time

Part Time

Position/Title

Type of Business

Business Phone

Gross Monthly Income(Required)

Name of Employer #2

Address of Employer

Street Address Address Line 2 City State ZIP Code

Self Employed

Years on this job

Status

Full Time

Part Time

Position/Title

Type of Business

Business Phone

Gross Monthly Income

Name of Employer #3

Address of Employer

Street Address Address Line 2 City State ZIP Code

Self Employed

Years on this job

Status

Full Time

Part Time

Position/Title

Type of Business

Business Phone

Gross Monthly Income

NOTICE: 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.

Income

Other Income

Amount

Co-Applicant

Name of Employer #1

Address of Employer

Street Address Address Line 2 City State ZIP Code

Self Employed

Years on this job

Status

Full Time

Part Time

Position/Title

Type of Business

Business Phone

Gross Monthly Income

Name of Employer #2

Address of Employer

Street Address Address Line 2 City State ZIP Code

Self Employed

Years on this job

Status

Full Time

Part Time

Position/Title

Type of Business

Business Phone

Gross Monthly Income

Name of Employer #3

Address of Employer

Street Address Address Line 2 City State ZIP Code

Self Employed

Years on this job

Status

Full Time

Part Time

Position/Title

Type of Business

Business Phone

Gross Monthly Income

NOTICE: 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.

Income

Other Income

Amount

HOUSING INFORMATION

Own or Rent

Own

Rent

Since

Monthly Housing/Rent

Present Value

Date Purchased

CASH ASSET INFORMATION

Account Information

Financial Institution Name

Saving Account Balance

Checking Account Balance

To complete this Consumer Loan Application, you will be requested to provide a complete listing of your assets and liabilities. A loan officer will contact you with more information.

DRIVER'S LICENSE UPLOAD

Please upload an image of the front of the Applicant & Co-Applicant Driver Licenses (other IDs may be acceptable)

Applicant ID

Accepted file types: jpg, jpeg, png, Max. file size: 8 MB.

Co-Applicant ID

Max. file size: 8 MB.

I/We hereby apply for the loan or credit described in this application. I/We certify that I/We made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.

Applicant Name(Required)

Date(Required)

Co-Applicant Name

Date

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