PremierBank is based in Fort Atkinson, Wisconsin and has physical locations in Jefferson, Rock, and Walworth Counties focusing on lending to people in the south central Wisconsin area.

Loan Information

Please Note: Alimony, child support, or maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation. Notice to married applicant: No provision of a marital property agreement, a unilateral statement under Wis. Stat. sec 766.59 or a court decree under Wis. Stat. sec 766.70 adversely affects the interests of the bank unless prior to the time the credit is extended, the bank is furnished with a copy of the agreement statement or decree, or has actual knowledge of the adverse provision when the obligation to the bank is incurred. Submission of this form authorizes PremierBank to verify information provided herein, including but not limited to employment and credit history.

Housing Information

Please Note: Alimony, child support, or maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation. Notice to married applicant: No provision of a marital property agreement, a unilateral statement under Wis. Stat. sec 766.59 or a court decree under Wis. Stat. sec 766.70 adversely affects the interests of the bank unless prior to the time the credit is extended, the bank is furnished with a copy of the agreement statement or decree, or has actual knowledge of the adverse provision when the obligation to the bank is incurred. Submission of this form authorizes PremierBank to verify information provided herein, including but not limited to employment and credit history.

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. You will be required to come into one of our locations to complete the loan process. (Sign loan papers, verify information, etc.)

Notice: We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.
For the purpose of obtaining the credit described above, and any future credit granted to the undersigned by the creditor named above, the undersigned, jointly and severally, (1) represent that the above statements are true and complete, (2) authorize the creditor named above, or its agents, to verify them and obtain additional information concerning our credit, employment history or any other information including credit reports (although the creditor may rely on these statements without any further verificaation), to furnish, to the extent not prohibited by applicable law, credit experience with me to others, and to answer my questions about our credit experience and other financial relationships with the creditor, and (3) agree to the provisions of any rules, regulations or agreements of the creditor governing such credit. This application is creditor's property.
The creditor may share information bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living with its affiliates unless (1) I direct the creditor at the address above that such information is unrelated to my transactions or experiences with the creditor and may not be shred by the creditor with its affiliates, (2) the information constitutes "medical information" as defined under applicable federal law, or (3) the information when provided to an affiliate would constitute a "consumer report" under applicable federal law.

The undersigned understand that it may be a crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts.

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