Loan Application

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REQUEST FOR LOAN APPLICATION
If you would like to be contacted by Kentland Bank regarding a potential loan request, please fill in the information, print the form on your printer and then fax it or mail to:

Kentland Bank P.O. Box 145 Kentland, IN 47951 219-474-5155 Fax 219-474-5071	Lake Village P.O. Box 245 Lake Village, IN 46349 219-992-3313 Fax 219-992-2501	Rensselaer P.O. Box 164 Rensselaer, IN 47978 219-866-4142 Fax 219-866-4514	Roselawn: P.O. Box 304 Roselawn, IN 46372 219-345-4646 Fax 219-345-2038

First Name
Last Name
Street Address
City
State
Zip-Plus 4	-
Home Phone	- -
Work Phone	- -
Type of Application Requested