Fidelity Bank Automobile Loan Application

Call 1 800 581 5363 to apply by Phone, or Fax to the Fidelity Bank office nearest you. Applications also accepted by Mail, or in Person at any location.
675 Main St Fitchburg Fax 978 343-2031	29 Main St Leominster Fax 978 537-0569	330 Main St. Gardner Fax 978 632-0430	25 Main St Shirley Fax 978 425-4358	97 Elm St Millbury Fax 508 865-0940

Amount $ Term Individual Jointly Current Pay Stub Purchase Agreement
Year Make Model Sale Price $
Seller/Dealer			Insurance Broker
Applying for this loan			CO-BORROWER
Name	Phone Number		Name	Phone Number
Address	Years There		Address	Years There
City	Zip		City	Zip
-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Own Rent		-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Own Rent
Date of Birth	Social Security #		Date of Birth	Social Security #
Number of Dependents			Number of Dependents
Previous Address (if less than 2 years at current address)	Years There		Previous Address (if less than 2 years at current address)	Years There
Current Employer			Current Employer
Years There	Employer Phone Number		Years There	Employer Phone Number
Gross Monthly Income	Current Position		Gross Monthly Income	Current Position
Previous Employer (if less than 2 years at current employer)	Years There		Previous Employer (if less than 2 years at current employer)	Years There
Other Income Source (If you do not wish to rely on alimony, child support, or seperate maintenance for repayment of this loan, such income need not be revealed)	Amount		Other Income Source (If you do not wish to rely on alimony, child support, or seperate maintenance for repayment of this loan, such income need not be revealed)	Amount
Your Bank Name	Balance		Your Bank Name	Balance
Checking			Checking
Savings			Savings
Credit Information (Borrower & Co-Borrower)
Name of Mortgage Provider or Landlord	Estimated Current Market Value of Home	Balance Owed		Monthly Payment
Auto Loan/Lease		Balance Owed		Monthly Payment
Other Debt		Balance Owed		Monthly Payment
Is Applicant or Co-Borrower obligated to pay Alimony, Child Support, or Maintenance?				Yes No
Is Applicant or Co-Borrower a Co-Maker, Endorser, or Guarantor on any loan or contract?				Yes No
Has Applicant or Co-Borrower ever filed bankruptcy?		Yes No   If yes, what year

	I REQUEST THAT MONTHLY PAYMENTS BE DEDUCTED DIRECTLY FROM MY ACCOUNT# AT FIDELITY BANK.
Type "yes" in this box to agree to these terms.	The above information is true and complete. I/We authorize the Bank to obtain credit information about me which the bank considers necessary to evaluate this application, and authorize the Bank to disclose any credit information which relates to this application or to any credit extended by the Bank as the result of this application. I understand that the Bank will retain this application whether it is approved or not.

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