Bank of Ripley

To Pre-qualify, simply complete and submit the following form. Before you begin, you should know that all applicants must be at least 18 years old. For Ozzie Owl Kids Club accounts, an adult must complete this form and be a joint owner.

A Bank of Ripley customer service representative will contact you concerning your choice of a new deposit account or loan account. We look forward to being "your bank" by providing you with quality accounts and exceptional service.

Feel free to contact us with any questions you may have.

All applicants must complete Section A. If you are pre-qualifying for a consumer deposit account, complete Sections A and B. If you are pre-qualifying for a consumer loan, complete Sections A and C. If you are pre-qualifying for both deposit and loan accounts, complete all three sections.

If you work in Tennessee and reside outside of Tennessee please contact us.

I am pre-qualifying for:
(check all that apply)

DEPOSIT ACCOUNTS
BanClub Reward Checking Money Market Savings Certificate of Deposit	BanClub Plus Now Chairman Club Ozzie Owl Kids Club	Free Checking Super Now Student Checking Christmas Club AFT
LOANS
Personal Installment Loan Mortgage Loan Auto Loan Home Loan Student Loan VA Loan	FMHA Loan

SECTION A - General Information

Last Name:*

First Name:*

Middle Initial:*

Home Address :*

City:*

State:
TN

Zip Code:*

Mailing Address (if applicable):

City:

State:
TN

Zip Code:

Previous Home Address:

City:

State:

Zip Code:

Home Phone (please include area code):*

Email Address:

Fax:

Date of Birth:*

Social Security Number:*

Employer:*

Employer Address:

City:

State:

Zip Code:

Employer Telephone:

Years There:

Position / Title:

Previous Employer (if less than 2 years at current employment):

Previous Employer Address:

City:

State:

Zip Code:

Joint Owner Information
By completing this section I acknowledge that I am pre-qualifying as a joint party for a joint application
*Note, you do not need to fill out this section unless you are pre-qualifying for a joint application

Last Name:

First Name:

Middle Initial:

Home Address :

City:

State:

Zip Code:

Previous Home Address:

City:

State:

Zip Code:

Home Phone (please include area code):

Email Address:

Fax:

Date of Birth:

Social Security Number:

Employer:

Employer Address:

City:

State:

Zip Code:

Employer Telephone:

Years There:

Position / Title:

Previous Employer (if less than 2 years at current employment):

Previous Employer Address:

City:

State:

Zip Code:

SECTION B - Deposit Account Information

CD Term:
(This is only if you choose a Certificate of Deposit)

CD Interest:
(This is only if you choose a Certificate of Deposit)

Amount of Initial Deposit:

How Initial Deposit Will Be Made:

I will come by Bank of Ripley / Bank of Tipton
Debit my existing Bank of Ripley / Bank of Tipton account
Account Number

Please Provide The Following Verification Information:

Name of Current Bank:

Address of Bank:

City:

State:

Zip Code:

Account Number :

TN Drivers License or State Iissue ID Number:*

Are you a US Citizen?
Yes
No

NOTE: If you do not have a drivers license or state issued ID, please call one of our Customer Service Representatives at (731) 635-1230.

Nearest Relative Not Living With You:

Address:

City:

State:

Zip Code:

Phone Number (including area code):

Mother's Maiden Name (for security purposes):

The Following Services Are Subject To Credit Approval:

*Would you like to apply for a Bank of Ripley VISA Check Card?:
Yes No

If so, please pick four numbers for your secret code:

Please reconfirm your secret code:

*Would you like to apply for overdraft protection?:
Yes No
If yes, please complete Income Information in Section C of this application

SECTION C - Loan Pre-qualification Information

Purpose of Loan:

If the credit line or loan is for home purchase, refinance, construction-to-perm, repair or maintenance, the following information is requested by the Federal government to monitor this lender's compliance with the Equal Credit Opportunity and Fair Housing Laws. The law provides that a lender may neither discriminate on the basis of this information nor on whether or not it is furnished. If you do not wish to furnish this information please indicate below.

Applicant:

You may select one of more designations for "Race"

I do not wish to furnish this information

Race or National Origin:
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Sex:

Ethnicity:
Hispanic or Latino
Not Hispanic or Latino

Co-Applicant:

You may select one or more designations for "Race"

I do not wish to furnish this information

Race or National Origin:
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Sex:

Ethnicity:
Hispanic or Latino
Not Hispanic or Latino

Amount Requested:

Gross Annual Income:

Length of Repayment Requested:

(NOTE: 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)

Do you own your home (or other real estate you would offer as collateral):
Yes No

If yes, please provide the value of that real estate:

Amount of First Mortgage:

Amount of Second Mortgage:

BY CLICKING ON THE SUBMIT BUTTON BELOW, I (WE) WISH TO PRE-QUALIFY FOR THE LOAN AND/OR DEPOSIT PRODUCTS LISTED ABOVE AND CERTIFY THAT ALL INFORMATION PROVIDED ABOVE IS CORRECT. I (WE) AUTHORIZE YOU TO CHECK MY (OUR) CREDIT AND VERIFY THE INFORMATION PROVIDED IN THIS FORM. I (WE) ALSO CERTIFY UNDER PENALTY OF PERJURY THAT THE SOCIAL SECURITY NUMBER(S) PROVIDED ABOVE IS/ARE CORRECT AND THAT I AM NOT (WE ARE NOT) SUBJECT TO BACKUP WITHHOLDING UNDER THE INTERNAL REVENUE CODE. I (WE) UNDERSTAND THAT ADDITIONAL INFORMATION MAY BE REQUIRED BEFORE A LOAN DECISION CAN BE MADE OR AN ACCOUNT ESTABLISHED PER THIS PRE-QUALIFICATION. I (WE) FURTHER UNDERSTAND THAT APPROVAL BY BANK OF RIPLEY/BANK OF TIPTON FOR ANY OF THE LOAN OR DEPOSIT PRODUCTS IS CONDITIONED ON MY (OUR) AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS CONTAINED IN THE APPLICABLE ACCOUNT CONTRACT AGREEMENT. I FURTHER AGREE TO RETURN ANY ACCESS DEVICE FOR OBTAINING FUNDS FROM ANY TYPE OF ACCOUNT UPON DEMAND BY BANK OF RIPLEY/BANK OF TIPTON.

I HAVE READ THE ABOVE STATEMENT AND AGREE TO THE TERMS SET OUT THEREIN.