Applicant Information:
Applicant Name: (First, Middle Initial, Last, Suffix)
By completing the e-mail address field, you authorize us to communicate with you using electronic mail.
E-mail Address (Optional)
Business Name (Business Loans Only)
Address:
Address:
City:
State:
Zip Code:
Country:
Phone:
Birth Date:
* Length of Residence:	Years Months
* Social Security Number:	--
* Number of Dependents:
Previous Address (If less than two years):
City, State, Zip Code:
Country:
* Length of Residence:	Years Months
* Employer:
* Occupation:
Business Phone:
* Length of Employed:	Years Months
* Previous Employer (If less than two years):
* Occupation:
Business Phone:
Length of Employed:	Years Months
Gross Salary (fill in one):	Weekly (W)  Bi-Weekly (B)  Monthly (M)  Annual (A)
Alimony, child support or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony, child support or separate maintenance received under:   COURT ORDER (C)  WRITTEN AGREEMENT (W) ORAL AGREEMENT (O)
Other Income (fill in one):	W  B  M  A
Source:
Name of Nearest Relative Not Living With You:
Address:
City, State, Zip Code:
Phone:
Relationship:
Co-Applicant Information:
Applicant Name: (First, Middle Initial, Last, Suffix)
Address:
Address:
City:
State:
Zip Code:
Country:
Phone:
Birth Date:
* Length of Residence:	Years Months
* Social Security Number:	--
* Number of Dependents:
Previous Address (If less than two years):
City, State, Zip Code:
Country:
* Length of Residence:	Years Months
* Employer:
* Occupation:
Business Phone:
* Length of Employed:	Years Months
* Previous Employer (If less than two years):
* Occupation:
Business Phone:
Length of Employed:	Years Months
Gross Salary (fill in one):	Weekly (W)  Bi-Weekly (B)  Monthly (M)  Annual (A)
Alimony, child support or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying   this obligation. Alimony, child support or separate maintenance received under:   COURT ORDER (C)  WRITTEN AGREEMENT (W) ORAL AGREEMENT (O)
Other Income (fill in one):	W  B  M  A
Source:
Please charge the monthly payment for this obligation to my:
CHECKING  SAVINGS ACCOUNT WITH YOUR BANK
Yes No
ACCOUNT NUMBER
Checking Savings Accounts:
Bank Name:
Account Number:
Account Type:
Bank Name:
Account Number:
Account Type:

Everything I have stated in this application to is correct to the best of my knowledge. I understand you will retain this application whether not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. If I am applying for a line credit, I agree to be bound by the terms and conditions of the line of credit agreement and disclosure statement which you will send to me. If I am applying for a line of credit or loan secured by real estate, my signature below acknowledges receipt of the disclosure statement and brochure for the type of line or loan secured by real estate stated above. OH Residents Only: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit agency maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law. NY Residents Only: A consumer credit report may be requested in connecting with this application or In connection with updates, renewable or extensions of any credit granted as a result of this application Upon my request. I will be informed whether or not a consumer credit report was requested, and if so, the name and address of the agency that furnished such report.

If I do not qualify for credit with you under your standard lending guidelines, I authorize you to consider my application for credit under the terms and conditions of your optional Expanded Credit program, which is offered through special arrangements with non PNC Bank lenders. I authorize you to forward my application, credit report, and all other documents to non PNC Bank lenders participating in the Expanded Credit Program. I understand that if my application is approved under the Expanded Credit Program, a non PNC Bank lender may either make the loan directly to me or purchase the loan from you. I also understand that the terms and conditions of Expanded Credit Program loan may differ from the terms and conditions of the loan for which I originally applied.
Yes, I/we wish to be considered for PNC Bank's Expanded Credit Program.
No, I/we do not wish to be considered for PNC Bank's Expanded Credit Program.