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Butler Rural Electric Cooperative, Inc.

Loan Application Dated : Account # Type of Loan Loan Amount Term Requested (months) Collateral Amount Term $ 500 to $ 2,499 - 18 months maximum $ 2,500 to $ 4,999 - 48 months maximum $ 5,000 to $ 9,999 - 60 months maximum $ 10,000 to $ 25,000 - 120 months maximum Note: minimum term of 12 months for all loan amounts 3% fixed interest rate

If this is an application for a Joint Loan involving you and another person, Sections 1 and 2 must be completed and both parties must sign the application. Section 1 - Applicant & Member Last Name City Date of Birth Employer First Name County Social Security # Employer's Address State Zip Code Street Address How Long? Year(s)

Previous Address - if less than 2 years at present address Monthly Mortgage

Telephone #

Employer's Telephone # Position

Length of Employment Year(s)

Name and Telephone # of nearest living relative not living with you

Section 2 - Co-Applicant Last Name City Date of Birth Employer First Name County Social Security # Employer's Address State Zip Code Street Address How Long? Year(s)

Previous Address - if less than 2 years at present address

Telephone # Employer's Telephone # Position Length of Employment Year(s)

Name and Telephone # of nearest living relative not living with you

Continued on Back

Gross Annual Income Applicant's Salary Co-Applicant's Salary Other Income (list source) Total Gross Annual Income Do you have any additional mortgages or liens against the home? Do you have any additional mortgages or liens outside the home? Are you obligated to pay alimony, child support, or separate maintenance? Have you ever had a car or other merchandise repossessed? Have you ever filed bankruptcy? Year Monthly Amount Total Balance Monthly Amount

Name of Company

Ohio Equal Credit Opportunity Notice: The Ohio law against discrimination requires that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. By signing below, applicant certifies that all information submitted herein is true, accurate and complete and there are no obligations other than those itemized on this application. Applicant arthorizes the Cooperative to verify employment information and to obtain and/or exchange whatever credit information the Cooperative deems necessary in processing, review or collection of credit applied for in this application. THE UNDERSIGNED FURTHER WARRANTS THAT A BANKRUPTCY PROCEEDING IS NEITHER PRESENTLY IN PROGRESS NOR ANTICIPATED. Applicant understands that approval is granted upon the information provided and may be rescinded if the information provided changes the results of the financial analysis by the Cooperative. Applicant's Signature Co-Applicant's Signature Date

List Of Additional Mortgages

Additional Mortgage Monthly Amounts