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Consumer Loan Application

Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Is your mailing address the same as your physical address? *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Date of Birth *

Social Security Number *

Immigration Status *

Primary Phone Number *

Secondary Phone

Email Address *

Drivers License / ID Number *0 / 30

ID - State Issued (or Government Department)0 / 100

Income Type *EmployedSelf-EmployedBenefits (Permanent)Other

Type of Benefits0 / 500

Current Employer *0 / 100

Nature of Business *0 / 500

Length of Employment (years) *

Monthly Income *

Would you like any other sources of income considered for this application? *

Additional Sources of IncomeAlimony, child support, separate maintenance income, etc.0 / 500

Monthly Income from Other Sources

Loan Information

Loan Product *

Other Loan Request0 / 500

Loan Type *

Please provide a brief description of the collateral that would be used to secure your loan: *0 / 1000

Purpose of Loan: *

Other Purpose for Loan Request:0 / 1000

Loan Officer *

Acknowledgement - Permission to Pull Credit *I read, understand, and consent to having my credit pulled by CBOTSBy clicking the checkbox above, you understand and agree that you are authorizing Citizens Bank of the South (CBOTS) to each obtain consumer reports and related information about you from one or more consumer reporting agencies, such as Equifax. You also authorize CBOTS to verify information in your application for credit, and you agree that CBOTS may contact third parties to verify any such information. You direct CBOTS to use your consumer reports to authenticate your identity, to make credit decisions, and for other related purposes. You expressly authorize CBOTS to obtain consumer reports from consumer reporting agencies about you when you apply for credit and periodically throughout the term of your credit product.

Acknowledgement - Credit Application Disclosure for Insurance/Annuity Products *I read and understand the Credit Application Disclosure for Insurance/Annuity ProductsIMPORTANT NOTICE DO NOT ACKNOWLEDGE THIS AGREEMENT AND CONSENT UNTIL YOU READ IT AND UNDERSTAND ITS CONTENTS CREDIT APPLICATION DISCLOSURE FOR INSURANCE/ANNUITY PRODUCTS Insurance and/or annuity products may be solicited, offered or sold in connection with the type of credit for which you have applied. We cannot, as a condition for you to obtain the credit: *require you to purchase an insurance product or annuity from us, or from any of our affiliates; or *make you agree not to obtain, or prohibit you from obtaining, an insurance product or annuity from another company that is not affiliated with us. INSURANCE/ANNUITY PRODUCTS DISCLOSURE Any insurance product or annuity that you may agree to purchase from us or our affiliates: • is not a deposit or other obligation of ours, or our affiliates; and • is not guaranteed by us or our affiliates; and • is not underwritten by us; and • is unrelated (for annuities) and not a condition • to the provision or term of any financial service or activity; and • is not insured by the Federal Deposit Insurance Corporation (FDIC) or any other agency of the United States (with the exception of any federal crop insurance or federal flood insurance); and • is not insured by us or our affiliates; and is subject to investment risk, including interest rate risk. The market value of the investment may fluctuate, causing possible loss of the principal amount invested.

Acknowledgement - E-SIGN Disclosure and Consent Agreement *I read, understand, and consent to the E-SIGN Disclosure and Consent AgreementThis E-Sign Disclosure and Consent Agreement (“Agreement”) applies to all Communications and required disclosures relating to your application for a loan with Citizens Bank of the South (“CBOTS”) and/or your actual loan, if any, with CBOTS. 1. Scope of Communications to Be Provided in Electronic Form You agree that we may provide you with any Communications that we may choose to make available in electronic format, to the extent allowed by law, and that we may discontinue sending paper Communications to you, unless and until you withdraw your consent as described below. Your consent to receive electronic communications and disclosures includes: • All legal and regulatory disclosures and communications associated with your loan application or your actual loan including those disclosures required by the Truth in Lending Act. • Notices or disclosures about the sale of your loan or a change in the servicing of your loan. • Privacy policies and notices. 2. Method of Providing Communications to You in Electronic Form All Communications that we provide to you in electronic form will be provided either (1) via e-mail, (2) by access to a web site that we will designate in an e-mail notice we send to you at the time the information is available, (3) to the extent permissible by law, by access to a website that we will generally designate in advance for such purpose, or (4) by requesting you download a PDF file containing the Communication. 3. How to Withdraw Consent You have the right to withdraw your consent to receive Communications in electronic form by calling one of our customer service representatives at 478.552.5116 (Sandersville), 912.871.2971 (Statesboro) or 478.387.0124 (Milledgeville). At our option, we may treat your provision of an invalid e-mail address, or the subsequent malfunction of a previously valid e-mail address, as a withdrawal of your consent to receive electronic Communications. We will not impose any fee to process the withdrawal of your consent to receive electronic Communications; however your access and use of Online Banking may be terminated. Any withdrawal of your consent to receive electronic Communications will be effective only after we have a reasonable period of time to process your withdrawal. 4. How to Update Your Records It is your responsibility to provide us with true, accurate and complete e-mail address, contact, and other information related to the Disclosure and your Account(s), and to maintain and update promptly any changes in this information. You can update information (such as your e-mail address) by calling one of our customer service representatives at 478.552.5116 (Sandersville), 912.871.2971 (Statesboro) or 478.387.0124 (Milledgeville). 5. Hardware and Software Requirements In order to access, view, and retain electronic Communications that we make available to you, you must have: • A personal computer or other device which is capable of accessing the internet. • An e-mail account with an Internet service provider and e-mail software in order to participate in our electronic Communications programs; • PDF reader: Adobe Reader or similar software may be required to view and print PDF files. You may download the most current version of the software identified above by going to www.adobe.com. • A printer (for printed copies) or a working hard drive or other storage device (to store electronic copies) 6. Requesting Paper Copies We may not send you a paper copy of certain communications which is available electronically from CBOTS, unless you request it, or we otherwise deem it appropriate to do so. You can obtain a paper copy of an electronic Communication by printing it yourself or by requesting that we mail you a paper copy, provided that such request is made within a reasonable time after we first provided the electronic Communication to you. To request a paper copy, call of our customer service representatives at 478.552.5116 (Sandersville), 912.871.2971 (Statesboro) or 478.387.0124 (Milledgeville). We reserve the right, but assume no obligation, to provide a paper (instead of electronic) copy of any Communication that you have authorized us to provide electronically. 7. Communications in Writing All Communications in either electronic or paper format from us to you will be considered “in writing.” You should print or download for your records a copy of this Agreement and any other Communication that is important to you. 8. Federal Law You acknowledge and agree that your consent to electronic Communications is being provided in connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures in Global and National Commerce Act, and that you and we both intend that the Act apply to the fullest extent possible to validate our ability to conduct business with you by electronic means. 9. Termination / Changes We reserve the right, in our sole discretion, to discontinue the provision of your electronic Communications, or to terminate or change the terms and conditions on which we provide electronic Communications. We will provide you with notice of any such termination or change as required by law. PLEASE NOTE: By clicking the checkbox above, you are consenting to the provisions of this Agreement.

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