Wednesday, September 8th, 2010
 

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Real Estate Agent:
 
Personal Information    
 

Primary Account Holder

Joint Account Holder

First Name *

Middle Name *

Last Name *

Home Phone *

Email Address *

Date of Birth *

Social Security No. *

- -

- -

Mother's Maiden Name

 
 

Drivers License Information

 

Primary Account Holder

Joint Account Holder

Drivers License Number

State / Expiration

 
 

Current Address Information

 

Primary Account Holder

Joint Account Holder

No. and Street *

City *

State / Zip *

Years There *

Housing *

Own Rent

Own Rent

Monthly Payment *

 
 

Employment Information

 

Primary Account Holder

Joint Account Holder

Present Employer *

Position *

Years There *

Business Phone *

Annual Gross Income *

Other Income

Other Income Source

 
 

Loan Information

Loan Amount

Loan Purpose

Loan Collateral

Closest Branch

 
 

Former Address (If less than 2 years)

 

Primary Applicant

Joint Applicant

No. and Street

City

State / Zip

Years There

 

By submitting this application you certify that you are at least 18 years of age and the information you have provided is correct and complete as of the date of this application. You authorize us to verify your credit and employment history. You agree that, if your application is approved, you will be bound by the terms and conditions set forth in the underlying account agreement.

NOTICE: CNB may obtain a consumer credit report (credit history) from consumer reporting agency (credit bureau) on the applicant(s) at the time of the application and may also obtain additional consumer credit reports in the future for updates, renewals, extensions and collection activity for any approved account. Upon request, the lender will tell the applicant whether the lender obtained a report and if so, the name and address of the consumer reporting agency, which provided the report. You may instruct Canandaigua National Corporation not to share information (other than information related to account history and our experiences with you) within the Canandaigua National Corporation family of financial company services companies, by calling us toll free at 1-800-724-2621. You have the right to notify the lender if it reports any inaccurate information about your account to a credit bureau. Such notices should be sent in writing to the lender at 72 S, Main St., Canandaigua, New York 14424. You consent to and authorize CNB and it's affiliates to monitor and/or record your telephone conversations with any of its representatives to ensure quality service. By submitting this application, applicant(s) agree that they have applied for the account as indicated above. They agree to pay the full amount of any credit extended by the lender, including finance charges and other fees that may be due under the terms of the account agreements if an account is opened.

   

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