Installment Loan ApplicationReturn by:Fax: (210) 637-4811 Mail: Farm Bureau Bank P.O. Box 33427 San Antonio, TX 78265-9865or Email: services@farmbureaubank.com

If you intend to apply for joint credit, please check here: Yes No(Joint Applicant will be contractually responsible)

Farm Bureau InformationHow did you hear about us? Ad Mail Web Farm Bureau Agent(Please check one) Insert Email Other: _______________________

Farm Bureau MembershipAre you a Farm Bureau Member? Yes NoFarm Bureau Number: ____________________________________ State of Membership:_________________________

Farm Bureau Agent ReferralAgent Name: ___________________________________________ Agent Referral Number: _______________________

Loan Purpose: Consumer Business Type of Loan: Collateral Purpose Other: ____________________ Vehicle Pre-Approval Motorcycle New Purchase from Dealer Recreational Vehicle Purchase from Individual All-Terrain Vehicle Refinance Boat Purchase from Individual with Lien Jet-Ski Snow Mobile Equipment

Are you trading in a vehicle: Yes No If yes, enter your monthly payment amount: $_______________________Amount Requested: $______________________________Loan Term Requested: 24 months 36 months 48 months 60 months 72 months Other: _________Payment Plan: Automatic Payment: Routing Number: _________________________ Account Number: ____________________________ Coupon Book

First Payment Due Day Requested: ___________________________________________________________________(Must be between the 1st-28th day of the month)

Whose name(s) will be on the vehicle title? _____________________________________________________________

Loan Information

By providing the information, I understand that this Farm Bureau Agent has requested that Farm Bureau Bank, P.O. Box 33427, San Antonio, Texas 78265-9865, extend credit to you. Information pertaining to your application may be shared with this agent in order to assist in the application process. To inquire about the status of your application, you may contact this Farm Bureau Agent or you may contact Farm Bureau Bank directly at (800) 492-3276.

Year: ______________ Make: ___________________________ Model: ________________________________________

Mileage: __________________________________________________________________________________________________

Vehicle Identification Number (VIN): __________________________________________________________________________

Body: ____________________________________________________________________________________________________

Collateral Information

Are you a US Citizen? Yes No (If no, you are not eligible for financing with Farm Bureau Bank)

Applicant Information

First Name: ________________________________ MI: ______ Last Name:___________________________________________Business Name: _____________________________________ Business Type: _________________________________________Business Tax ID Number: ____________________________________________________________________________________Social Security Number: ________ - ______ - ___________ Date of Birth: ______ /______ /________ (Must be of age to contract)Home Phone: (_____) _____ - _______ Cell Phone: (_____) _____ - _______ Mothers Maiden Name: ________________________Email Address: _____________________________________________________________________________________________Drivers License #: _____________________________________ State Issued: __________________________________________

Mailing AddressAddress: ______________________________________________________ City: ______________________________________State: _________________________________________________________ Zip: ______________________________________

Physical Address (If different from Mailing Address)Address: ______________________________________________________ City: ______________________________________State: _________________________________________________________ Zip: ______________________________________

Time at Residence: _____ /_____ Monthly Rent/Mortgage: $______________________________________________

Type of Residence: Own/Buying Rent Other: ________________________________________________Years / Months

Employment Information

Income Information

Do you or a member of your household derive any income from farming or other agricultural interests? Yes No

Employment Status: Employed Self Retired/Disabled Not Employed

Current Employer: ______________________________________________________________ Work Phone: (____) _____-_______

Length of Employment:_____ /_____ Position: __________________________________________________________________

Joint Applicant Information First Name: ________________________________ MI: ______ Last Name:___________________________________________Social Security Number: ________ - ______ - ___________ Date of Birth: ______ /______ /________ (Must be of age to contract)Home Phone: (_____) _____ - _______ Cell Phone: (_____) _____ - _______ Mothers Maiden Name: ________________________Drivers License #: _____________________________________ State Issued: __________________________________________

Mailing Address Same as Applicants Mailing AddressAddress: ______________________________________________________ City: ______________________________________State: _________________________________________________________ Zip: ______________________________________

Physical Address Same as Applicants Mailing AddressRequired if different from Applicant.

Address: ______________________________________________________ City: ______________________________________

State: _________________________________________ Zip: __________________________ Time at Residence: ____ / ____

Primary Applicants Income InformationIncome: $__________________________ Monthly Annually(If self-employed, income less business expenses.)

Other Income & SourceOther Income: $______________________ Source: _______________________ Monthly Annually(Your alimony, child support and separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.)

Years / Months

Years / Months

Account Protection Options

Guaranteed Asset Protection (GAP)Guaranteed Asset Protection (GAP) protects you against financial loss in the event your vehicle is damaged beyond repair (totaled) or stolen and never recovered. GAP eliminates or reduces out of pocket expenses for the remaining loan balance after loss settlement. Without GAP you would be responsible for paying the difference between the insurance settlement and the outstanding loan balance. A one-time fee will provide GAP coverage for the life of your Farm Bureau Bank vehicle loan.

Would you like to add Guaranteed Asset Protection? Yes No

Major Mechanical Protection (MMP)Major Mechanical Protection helps you avoid vehicle repair costs not covered by the standard manufacturer warranty. In most cases, this plan eliminates out-of-pocket expenses outside of your deductible. Bottom line, you can save a bundle over other service contacts or equivalent warranties with a Farm Bureau Bank MMP plan. Select yes below and a Farm Bureau Bank representative will contact you with a quote base on the information you provided.

Would you like to add Major Mechanical Protection? Yes No

If your loan is approved you may receive an installment loan and a credit card. Certain restrictions apply. If you already have a Farm Bureau Bank (Bank) credit card or another Simple Solutions loan, this loan will be considered an advance on your existing account. By submitting this application, you agree to, and have read the Farm Bureau Member Rewards MasterCard Terms & Conditions, which are available for review at https://www.farmbureaubank.com/Services/Documents.By submitting this application, you certify that all of the statements in this application are true and correct and are made for the purpose of obtaining credit. You authorize Farm Bureau Bank to obtain and verify additional information, including credit reports from credit reporting agencies. You understand that the Bank will rely on this information in deciding whether or not to grant credit to you and that the Bank may request further information as may be necessary to process your application. You understand that Farm Bureau Bank may access title, registration and lien information from an external source in order to perfect the title on a secured loan. You have read and agree to Farm Bureau Banks privacy notice and understand that you will receive Farm Bureau Banks privacy notice with the loan documents, and you may view the privacy notice at any time on the Banks disclosures page. All terms and conditions are subject to change._________________________________________________________________________________________________________________________________________________________________________

If the loan purpose is business or farm, you are submitting this application on behalf of the company as its authorized representative and as an individual guarantor of payment. In your individual capacity you (even though you may place a title or other designation next to your signature) unconditionally guarantee and promise to pay to Farm Bureau Bank all indebtedness of the business or farm, at any time, relating to this application, as well as, any extensions, increases, or renewals of