REFERENCES

___________________________________         __________      ________________________________         __________         
APPLICANT'S SIGNATURE                                 DATE                CO-APPLICANT'S SIGNATURE                DATE

AMOUNT APPROVED   $  ___________________        A.P.R.  ____________  %       TERM:  _______________  MONTHS

COLLATERAL  _____________________________________      CONDITIONS: ___________________________________________

APPROVED BY
LOAN OFFICER:

_________________________________________     ___________
                                                                        DATE        

="#962133" FACE="Arial">(724) 654-8485

REFERENCES

___________________________________         __________      ________________________________         __________         
APPLICANT'S SIGNATURE                                 DATE                CO-APPLICANT'S SIGNATURE                DATE

AMOUNT APPROVED   $  ___________________        A.P.R.  ____________  %       TERM:  _______________  MONTHS

COLLATERAL  _____________________________________      CONDITIONS: ___________________________________________

APPROVED BY
LOAN OFFICER:

_________________________________________     ___________
                                                                        DATE