BRANSON BANKm State Hwy, 248 I 3285 Falls Parkway I US Hwy.l60 Forsyth Branson I I Forsyth

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BRANSON BANKm 1501 State Hwy, 248 3285 Falls Parkway 15514 US Hwy.l60 Forsyth 417-334-9696 Branson www.bransonbank.com 417-546-6790 Forsyth ATTENTON: 9heck (.

1 BRANSON BANKm 1501 State Hwy, Falls Parkway US Hwy.l60 Forsyth Branson Forsyth ATTENTON: 9heck (.f) the appropriate boxes below and complete the applicable sections. 0 SECURED 0 UNSECURED. 0 NDVDUAL CREDT.- relying solely on my ncome or assets 0 NDVDUAL CREDT- relying on my ncome or assets as well as income or assets from other sources 0 JONT CREDT- we are applying for joint credit (initials) DATE.:. CLASS NO ACCOUNT NO. -' ' APPROVED[) BY ~ DECLNED AMOUNT fleouested FOR HOW LONG PAYMENT DATE DESRED WANT TO REPAY PROCEEDS OF LOAN TO BE USED FOR: MONTHLY [) BY DRVER'S LCENSE NO. GROSS: $ NET:$ f you do not wish to have t before the credit request paid off? DRVER'S LCENSE NO. POSTON OR TTLE GROSS: $ SALARY PER MONTH NET:$ Written Agreement 0 OTHER PARTY Unmarried (ncluding single, divorced, and widowed) (page 1 of 2)

2 ._ <- _. ~- _' " _$EQtfON D:... A$:SEt :-&:.oeatlnp'orma1'1on ; 1f S!i!l'll_9ii a h~ll 1J_el#t tjil ropl~lj'd, 'ihl~ $Jt~lli!~ ;thouta \t!f.e9mfll6p!"ci'!:ltvilllftotdfi:n:!(t:loii ~l)otit b"r;l'fh _iii-e Apptifitmt and Jolti't Ap})flc~:nt t~r o~hlir ~er-!m; ' ~ ~tea(fe,m ar~,a_)plihal'\~re\ljt~d l:\_~otjl)_jj~lon ~,Wtfh :011._"A" J'f,S!lel:tolt; 9We1! nohi!i~p!llted..- oli~v D'lliii fnfbtmjf{fttl'i llbtillt lha, ii\)jplill1in~ ~ ihl& Ss-ctl6tt. CHECKNG ACCOUNT NUMSER(SJ,SAVNGS ACCOUNT NUMBER(S) CERTFCATE OF DEPOST(S) MARKETABLE SECURTES '(issuer, type, no. of shares) (Use separate sheet f necessary.) DESCRPTON OF ASSETS NAME N WHCH THE ACCOUNT S CARRED SUBJECT TO:DEBT VAlUE - i i REAL ESTATE (location, date acquired) LFE NSURANCE {ssuer, face value) AUTOMOBLES (make, model, year) OTHER (list) TOTAL ASSETS '. (ncluding CREDTOR LANDLORD OR MORTGAGE HOLDER AUTOMOBLES (describe) charge accounts, nstallment contracts,. credit cards, rent, mortgages and other obligations. Use separate she.et f necessary.) 0 0 ACCOUNT NUMBER Rent.Payment Mortgage NAME N WHCH THE ACCOUNT S CARRED ORG'NAL AMOUNT (OMT RENT) $ $ PRESENT BALANCE (OMT RENT) $. MONTHLY PAYMENTS $ TOTAL DEBTS $ $ Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable): Are you obligated to make Alimony, Support or Maintenance- Payments? 0 0 Yes f yes, to (Name & Address) ,----'----' Amt. per month $ -' Ar~ you a co-maker, endorser, or _guarantor on- any loan or contract? 0 0 Yes f yes, for whom? To whom? Are there any unsatisfied judgments against you7 0 0 Yes f yes, to whom owed7 Amount $ Have you been declared bankrupt in the last 10 years? 0 0 Yes f yes, where? Year? PROPERTY DESCRPTON NAMES & ADDRESSES OF ALL CO-OWNERS OF THE PROPERTY F THE SECURTY S REAL ESTATE, GVE THE FULL NAME OF YOUR SPOUSE (f any). Ji!Wf!jli!;l 'i' 1 certify that everything 1 have stated n this application and on any attachments s correct. You may keep this application whether?r not t is apprnved. By signing below 1 authorize you to- check my credit and employment history and to answer.questions others may ask you about my credit record w1th you. understand that 1 must update credit nformation at your request if my financial condition changes. Applicant's Signature Data Other Signature (Where Applicable) Date (pag<t 2 of 2)

3 FEDERAL CREDT APPLCATON NSURANCE DSCLOSURE. have applied for ;:~n extension of credit with you. You are soliciting, offering, or selling me an insurance product or annuity in connection with' this extension of credit. FEDERAL LAW PROHBTS YOU FROM CONDTONNG THE EXTENSON OF CREDT ON ETHER: 1. My purchase of an insurance product or annuity from you or from any of your affiliates; or 2. My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity. By signing, acknowledge that have received a copy of this form on today's date. Unless this disclosure is provided electronically or have applied for credit by mail, also acknowledge that you have provided this disclosure to me orally Consumer Date Consumer Date ~ 2001 Bankers Systems, nc., St. Cloud, MN Form NS-FED 2/15/2001 (page 1 of 1

4 FACTS WHAT DOES BRANSON BANK DO WTH YOUR PERSONAL NFORMATON? Rev. 12/ Financial companies choose how they share your personal information. Fe.deral law gives. consumers the right to limit some but not allsharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do. The types of personai information we collect and share. depend on the product or service you have with us. This information can include: Social Security number and account balances credit history and transaction history income and employment information When you are no longer our customer> we continue to share your information as described in this notice. All financial companies.need to share customers' personalinformation to run their everyday business. n the section below, we list the reasons financial companies can share their customers' personal information; the reasons Branson Bank chooses to share; and whether you can limit this sharing. For our everyday business purposessuch as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus For our marketing purposesto offer our products and services to you For joint marketing with other financial companies For our affiliates' everyday business purposesinformation about your transactions arid experiences For our affiliates' everyday business purposesinformation about your creditworthiness For our affiliates to market to you For nonaffiliates to market to you Yes Yes Yes We dori't share We don't. share We don't share We don't share Caii41T.,.,A o&:q6 or go to

5 How does Branson Bank protect my personal information? How does Branson Bank collect my personal information? To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. We collect your personal information, for example, when you apply for a loan or make deposits or withdrawals from your account give us your contact information or open an account use your credit or debit card.. Why can't limit all sharing? Federal law gives you the right to limit only sharing for affiliates' everyday business purposes- information about your creditworthiness affiliates from using your information to. market to you sharing for nonaffiliates to market to you State laws and individual companies may give you additional rights to limit sharing. Affiliates naffiliates Joint marketing Companies related by common ownership or control. They can be financial and nonfinancial companies. Branson Bank has no affiliates. Companies not related by common ownership or control. They can be financial and nonfinancial. companies.... Branson Bank does not share with nonaffiliates so they can market to you. A farina agreement between nonaffiliated financial. companies that together market financial products or services to you. Our joint marketing partners include credit card companies and cbmpanies that provide financial services. laser PRO l~ Vw Copr. tt.nand Fn.rxW Solvlklna. nc AU RlgtO ~ S."tl.ASE.RPRo.CN..PL'PRJVOiS2.FC

l SECURED other sources FOR HOW LONG PAYMENT DATE DESIRED WANT TO REPAY l MONTHLY l SECTION A - INDIVIDUAL APPLICANT INFORMATION

l SECURED other sources FOR HOW LONG PAYMENT DATE DESIRED WANT TO REPAY l MONTHLY l SECTION A - INDIVIDUAL APPLICANT INFORMATION AMOUNT REQUESTED NAME (Last, First, Middle) CREDIT APPLICATION IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You