Getting Started

We’d like to help you get started, at your convenience, exploring your lending options at Black River Country Bank! Please thoroughly complete the form below and one of our Loan Officers will be in touch within 2 business days to discuss and help you work through and complete the process. Please note, you must be 18 years old and a U.S. Citizen to submit this form. Please call us at 715-284-9448 with any questions.

Just so you know, this form uses 256 bit SSL encryption, ensuring that no one else will see your personal information while it is in-transit. Please view our privacy policy for more information.

Loan * Loan Amount * Loan Purpose * Collateral *

Personal Information

First Name * Middle Name Last Name * Social Security Number/EIN * Why do we ask? Date of Birth * Marital Status Residential Street Address (Not a P.O. Box) * City * State * Zip * Phone Number * Email Address *

Employment Information

Employer Name Employer Address Gross Monthly Income Position Business Phone Number Other Monthly Income

Joint Applicant Personal Information

First Name Middle Name Last Name Social Security Number/EIN Date of Birth Marital Status Address City State Zip Phone Number Email Address

Joint Applicant Employment Information

Employer Name Employer Address Gross Monthly Income Position Business Phone Number Other Monthly Income

Financial Information

Applicant Deposit Account Information

Applicant Financial Institution Checking Account (Balance) Savings Account (Balance)

Joint Applicant Deposit Account Information

Joint Applicant Financial Institution Checking Account (Balance) Savings Account (Balance)

Comments

Anything else you would like us to know pertaining to above? How did you learn about us? Online Search Friend/Family BRCB Website Newspaper Radio Billboard Industry Publication E-mail Other:

IMPORTANT

Black River Country Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form I/We grant permission to do so.

This document is being secured using SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Black River Country Bank.

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Thank you for submitting your Getting Started form to BRCB. We will be in touch with you within 2 business days.