To Apply, having already read and accepted account disclosures, simply complete and submit application. First National Bank of Cokato, upon approval, will send to you a new account packet. After executing the enclosed documents as indicated, return to us to activate your account.

A representative from First National Bank of Cokato may contact you to verify your account application. Feel free to contact us with any questions you may have.

* = Required Field

If you work in Minnesota and reside outside of Minnesota please contact us.
I am applying for:
(check all that apply)		 LOANS
Consumer
Real Estate
Agricultural
Commercial
Student
SECTION A - General Information
Last Name:*
 First Name:*
Middle Initial:*
Home Address :*
 City:*
 State:
MN		 Zip Code:*
Mailing Address (if applicable):
 City:
 State:
MN		 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 Applicant Information
*Note, you do not need to fill out this section unless you are applying 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:
Please Provide The Following Verification Information:
Name of Current Bank:
 Address of Bank:
 City:
State:
 Zip Code:
 Account Number :
MN Drivers License or State Issue ID Number:*
 Are you a US Citizen?
Yes
No
NOTE: If you do not have a driver's license or state issued ID, please call one of our Customer Service Representatives at (320 ) 286 - 2191
Nearest Relative Not Living With You:
 Address:
 City:
State:
 Zip Code:
 Phone Number (including area code):
Mother's Maiden Name (for security purposes):
SECTION B- Loan Application 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.

The creditor shall also inform the applicant(s) that if the applicant(s) chooses not to provide the information, the creditor is required to note the race or national origin and sex on the basis of visual observation or surname.
Applicant:     
I do not wish to furnish this information
Race or National Origin:

 Sex:
Co-Applicant:     
I do not wish to furnish this information
Race or National Origin:

 Sex:
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) APPLY FOR THE LOAN AND/OR DEPOSIT PRODUCTS LISTED ABOVE AND CERTIFY THAT ALL INFORMATION PROVIDED ABOVE IS CORRECT AND AUTHORIZE YOU TO CHECK MY (OUR) CREDIT AND VERIFY THE INFORMATION PROVIDED IN THIS APPLICATION. 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 DECISION CAN BE MADE REGARDING THIS APPLICATION. I (WE) FURTHER UNDERSTAND THAT APPROVAL BY First National Bank of Cokato 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 LOAN AGREEMENT AND/OR DEPOSIT AGREEMENT. I FURTHER AGREE TO RETURN ANY ACCESS DEVICE FOR OBTAINING FUNDS FROM ANY TYPE OF ACCOUNT UPON DEMAND BY First National Bank of Cokato.
I HAVE READ THE ABOVE STATEMENT AND AGREE TO THE TERMS SET OUT THEREIN.
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