Consumer Loan Application

Consumer Loan Application - production

Loan Purpose

Type of Application/Loan Request

*This application is subject to a separate credit agreement disclosing terms and conditions of extended credit.
*Additional information about rates, fees, and other costs related to the Visa Credit Card may be found here[link to additional information in modal dialogue box]

Is this a home improvement loan?


Complete the question on Marital Status only if you live in a community property state (AZ, CA, ID, LA, NV, NM, TX,WA).



Marital Status

Do you

How Long?
How Long?
Co-Applicant Co-Signer

Are you a:


Do You

Other Income

You do not have to list alimony or maintenance unless you want us to consider it in order to obtain this credit. If you are married and live in a community propery state, your earnings, your spouse's earnings, and all "other income" are presumed to be community property unless you indicate otherwise.





The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal 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







  1. Electronic Signature Agreement. By selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "Submit" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide Bank address (500 W. Broadway, Farmington, NM 87401) and website address(, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the Bank. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature in obtaining a Bank OnLine service constitutes your agreement to be bound by the terms and conditions of the Bank OnLine Disclosures and Agreements as they exist on the date of your E-Signature.
  2. Consent to Electronic Delivery. You specifically agree to receive and/or obtain any and all Bank OnLine related "Electronic Communications" (defined below) via website address. The term "Electronic Communications" includes, but is not limited to, any and all current and future notices and/or disclosures that various federal and/or state laws or regulations require that we provide to you, as well as such other documents, statements, data, records and any other communications regarding your relationship with the Bank. You acknowledge that, for your records, you are able to use the bank online services to retain Electronic Communications by printing and/or downloading and saving this Agreement and any other agreements and Electronic Communications, documents, or records that you agree to using your E-Signature. You accept Electronic Communications provided via the Bank as reasonable and proper notice, for the purpose of any and all laws, rules, and regulations, and agree that such electronic form fully satisfies any requirement that such communications be provided to you in writing or in a form that you may keep.
  3. Paper version of Electronic Communications. You may request a paper version of an Electronic Communication. You acknowledge that the Bank reserves the right to charge you a reasonable fee for the production and mailing of paper versions of Electronic Communications. To request a paper copy of an Electronic Communication contact us at 505-599-0135.
  4. Revocation of electronic delivery. You have the right to withdraw your consent to receive/obtain communications via the Bank OnLine at any time. You acknowledge that the Bank reserves the right to restrict or terminate your access to Bank OnLine if you withdraw your consent to receive Electronic Communications. If you wish to withdraw your consent, contact us at 505-599-0135.
  5. Valid and current email address, notification and updates. Your current valid email address is required in order for you to obtain bank OnLine services. You agree to keep the Bank informed of any changes in your email address. You may modify your email address by submitting a written request to the bank, visit a branch location or submit a secure message thru online banking. The Bank may notify you through email when an Electronic Communication or updated agreement pertaining to OnLine is available. The Bank may also use OnLine for Electronic Communications. It is your responsibility to use OnLine regularly to check for Electronic Communications and to check for updates to this Agreement.
  6. Hardware, software and operating system. You are responsible for installation, maintenance, and operation of your computer, browser and software. The bank is not responsible for errors or failures from any malfunction of your computer, browser or software. The bank is also not responsible for computer viruses or related problems associated with use of an online system. The following are the minimum hardware, software and operating system requirements necessary to use OnLine and receive Electronic Communications:
    • Processor - IBM compatible Pentium PC running Windows 2000
    • Memory - 4MB RAM
    • Disc Space - 50 MB's Free Space
    • Monitor - 800 x 600 resolution
    • Browser - Microsoft Internet Explorer 6.0 or higher
    • Internet access - 28.8 modem or better
  7. Controlling Agreement. This Agreement supplements and modifies other agreements that you may have with the Bank. To the extent that this Agreement and another agreement contain conflicting provisions, the provisions in this agreement will control (with the exception of provisions in another agreement for an electronic service which provisions specify the necessary hardware, software and operating system, in which such other provision controls). All other obligations of the parties remain subject to the terms and conditions of any other agreement.

You agree that the information on this electronic application is complete and correct. You agree that Citizens Bank may verify any of this information and may check your credit and employment history from time to time. You agree that Citizens Bank may also ask questions from others about their credit and account experience with you

To obtain electronic services and communications, indicate your consent to the terms and conditions of this Agreement by clicking on the "Submit" button.


It is recommended that you print a copy of this Agreement for future reference.

Check the box next to "I'm not a robot".