Dealer Direct (First Community Bank)

IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

Applicant Information (This application is for secured credit only)

Basic Information
Your Personal Details
Time at Address (if less than 2 years, give previous address)
Banking Information
Gross Monthly
Alimony Information

Alimony, child support, or separate maintenance income need to be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Alimony, child support, separate maintenance received under:

*Includes Single, divorced or widowed

Equipment Information (Attach dealer invoice if available)
Quantity Model #s Description Serial # Price

This Application for Credit (“Application”) is to First Community Bank (“FCB”). I have read this Application, and everything stated in it is true. I authorize FCB to check my credit, employment history, or any other information, and to report such information, and its credit experience with me, to others. I am at least 18 years of age. I hereby certify that the property purchased pursuant to this application is for my personal and/or business use; that I am fully responsible for making all payments for such property; that such property will be in my possession or under my control until the amount financed and all finance charges have been paid in full; and that I am not purchasing any property financed through FCB for the benefit of another without the written approval of FCB. I understand that I must update credit information at FCB’s request if my financial condition changes.