| LOAN APPLICATION |
LOAN AMOUNT REQUESTED
$ |
ESTIMATED REPAYMENT PERIOD
MONTHS |
REQUESTED PERIODIC PAYMENT
$ |
PURPOSE OF LOAN COLLATERAL |
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MARRIED APPLICANTS may apply for a separate account. A Credit Union may only extend direct credit to member. A joint applicant for credit will be considered a guarantor or co-signer if such person is not a credit union member. Check the type of credit account you wish to apply for.
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INDIVIDUAL CREDIT - You must complete the applicant section and the other section about your spouse if:
You live in a community property state (AK, AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI) or your Spouse will use the account, or you are relaying on your spouse's income as a source of repayment.
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JOINT CREDIT - If you are applying for a joint account or an account that you and another person will use, you must complete the applicant and other section. |
If you intend to apply for joint credit, you understand that the Credit Union may need to document any non-member as a guarantor/co-signer as explained above.
| X |
__________________________________________ |
X |
__________________________________________ |
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Applicant Signature |
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Co-Applicant Signature |
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INFORMATION ABOUT PROTECTION FOR YOUR LOANS
Group Credit Insurance is available on loans made to Credit Union members. Insurance is voluntary and not required to obtain credit. If you would like information about Group Credit Insurance, check below.
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YES |
SINGLE
CREDIT
LIFE INSURANCE |
AGE _____
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YES |
JOINT
CREDIT
LIFE INSURANCE |
AGE _____
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YES |
CREDIT
DISABILITY
INSURANCE |
AGE _____ |
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NO |
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NO |
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NO |
The Credit Union will disclose the cost of this Voluntary Insurance to you if you checked Yes. A separate election disclosing the terms and conditions of the Credit Insurance must be signed for the coverage to be effective. If you have attained or are over the ages indicated, you are not eligible for coverage. |
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Complete for secured credit or if you live in a community property state
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MARRIED |
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SEPARATED |
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UNMARRIED (Single, Divorced, Widowed) |
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| APPLICANT NAME |
DATE OF BIRTH |
| PRESENT ADDRESS (Street - City - State - Zip) |
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HOW LONG
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OWN |
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RENT |
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| PREVIOUS ADDRESS(ES) LAST FIVE YEARS |
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OWN |
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RENT |
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EMPLOYEE NO.
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HOME PHONE
( ) |
WORK PHONE
( ) |
EXT.
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ACCOUNT NO.
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SOCIAL SECURITY NUMBER
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DRIVERS LICENSE NUNMBER
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| NUMBER OF DEPENDENTS. EXCLUDE SELF ANY LISTED BY CO-APPLICANT
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| PRESENT EMPLOYER |
| EMPLOYER ADDRESS (Street - City - State - Zip) |
| JOB TITLE / GRADE |
SUPERVISOR NAME |
SUPERVISOR PHONE |
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| DATE EMPLOYED |
TYPE OF BUSINESS |
SELF-EMPLOYED |
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| IS MILITARY DUTY STATION TRANSFER EXPECTED WITHIN NEXT YEAR?
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WHERE |
ETS DATE |
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| EMPLOYMENT INCOME |
OTHER INCOME* |
SOURCE OF OTHER INCOME* |
| $ PER |
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$ PER |
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| *You need not reveal income from alimony, child support, or separate maintenance payments unless you want it considered in evaluating this credit application. |
| PREVIOUS EMPLOYER(S) NAME/ADDRESS |
STARTING DATE |
ENDING DATE |
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| ASSETS |
CURRENT DEPOSITS AT OTHER FINANCIAL INSTITUTIONS |
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NAME AND ADDRESS OF INSTITUTION |
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NAME AND ADDRESS OF INSTITUTION |
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NAME AND ADDRESS OF INSTITUTION |
| DESCRIPTION OF CLEAR TITLE ASSETS (CAR, PROPERTY) |
VALUE
$ |
Pledged As Collateral
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| (OTHER ASSETS) |
VALUE
$ |
Pledged As Collateral
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| REFERENCES |
| NAME AND ADDRESS NEAREST RELATIVE NOT LIVING WITH YOU |
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| NAME AND ADDRESS CLOSE PERSONAL FRIEND - NOT RELATIVE |
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| OTHER |
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Joint Applicant |
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Co-Signer / Guarantor |
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Complete for secured credit or if you live in a community property state
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MARRIED |
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SEPARATED |
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UNMARRIED (Single, Divorced, Widowed) |
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| APPLICANT NAME |
DATE OF BIRTH |
| PRESENT ADDRESS (Street - City - State - Zip) |
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HOW LONG
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OWN |
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RENT |
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| PREVIOUS ADDRESS(ES) LAST FIVE YEARS |
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OWN |
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RENT |
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EMPLOYEE NO.
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HOME PHONE
( ) |
WORK PHONE
( ) |
EXT.
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ACCOUNT NO.
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SOCIAL SECURITY NUMBER
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DRIVERS LICENSE NUNMBER
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| NUMBER OF DEPENDENTS. EXCLUDE SELF ANY LISTED BY CO-APPLICANT
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| PRESENT EMPLOYER |
| EMPLOYER ADDRESS (Street - City - State - Zip) |
| JOB TITLE / GRADE |
SUPERVISOR NAME |
SUPERVISOR PHONE |
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| DATE EMPLOYED |
TYPE OF BUSINESS |
SELF-EMPLOYED
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| IS MILITARY DUTY STATION TRANSFER EXPECTED WITHIN NEXT YEAR?
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WHERE |
ETS DATE |
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| EMPLOYMENT INCOME |
OTHER INCOME* |
SOURCE OF OTHER INCOME* |
| $ PER |
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$ PER |
|
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| *You need not reveal income from alimony, child support, or separate maintenance payments unless you want it considered in evaluating this credit application. |
| PREVIOUS EMPLOYER(S) NAME/ADDRESS |
STARTING DATE |
ENDING DATE |
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| ASSETS |
CURRENT DEPOSITS AT OTHER FINANCIAL INSTITUTIONS |
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NAME AND ADDRESS OF INSTITUTION |
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NAME AND ADDRESS OF INSTITUTION |
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NAME AND ADDRESS OF INSTITUTION |
| DESCRIPTION OF CLEAR TITLE ASSETS (CAR, PROPERTY) |
VALUE
$ |
Pledged As Collateral
|
| (OTHER ASSETS) |
VALUE
$ |
Pledged As Collateral
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| REFERENCES |
| NAME AND ADDRESS NEAREST RELATIVE NOT LIVING WITH YOU |
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| NAME AND ADDRESS CLOSE PERSONAL FRIEND - NOT RELATIVE |
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| OUTSTANDING DEBTS AND OBLIGATIONS - LIST EVERYTHING OWED, USE SEPARATE SHEET IF NEEDED |
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CHECK ONE
OR MORE |
NAME AND ADDRESS OF CREDITOR ACCT. NO. |
PAST
DUE |
ORIGINAL AMOUNT |
BALANCE |
MONTHLY
PAYMENT |
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HOUSE PAYMENT OR RENT |
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HOUSE PAYMENT OR RENT |
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AUTO LOAN |
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AUTO LOAN |
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DEPARTMENT STORES |
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CHILD SUPPORT |
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CHILD CARE |
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CREDIT CARDS |
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LOAN PAYMENTS |
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MISC. EXPENSES (UTILITIES, TELEPHONE, INSURANCE, ECT.) |
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| ATTACH SEPARATE SHEET IF NECESSARY |
TOTALS |
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$ |
$ |
$ |
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APPLICANT |
CO-APPLICANT |
| Have you ever filed a petition for bankruptcy (Personal or Business)? |
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YES |
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NO |
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YES |
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NO |
| Have you ever filed a petition for Chapter 13 Bankruptcy? |
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YES |
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NO |
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YES |
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NO |
| Are any suits pending, judgments filed, alimony or support awards against you? |
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YES |
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NO |
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YES |
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NO |
| Have you ever had any auto, furniture, or any property repossessed? |
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YES |
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NO |
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YES |
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NO |
| Are you a party in a lawsuit? |
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YES |
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NO |
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YES |
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NO |
| Do you have any outstanding judgments? |
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YES |
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NO |
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YES |
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NO |
| Is any income you have shown likely to reduce in the next two years? |
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YES |
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NO |
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YES |
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NO |
| Are you a co-maker or co-signer on any loan? If so, whom? |
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YES |
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NO |
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YES |
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NO |
| NAME OF OTHERS OBLIGATED ON LOAN AND NAME OF CREDITOR |
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YES |
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NO |
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YES |
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NO |
IF ANY YES ANSWERS TO QUESTIONS, EXPLAIN:
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| Are you a United States Citizen? |
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YES |
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NO |
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YES |
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NO |
| .............IF NO LIST STATUS |
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| It is the Credit Union policy to not discriminate against any applicant with respect to race, color, religion, national origin, sex, marital status, age, the recipient of public assistance, part time income, or exercising rights under any consumer protection credit act. In addition, it is our policy not to discriminate based on familial status or a handicap in the extension of credit for housing. It is the Credit Union's intent to comply with all consumer credit protection statutes and regulations.
YOU AGREE THAT EVERYTHING STATED IN THIS APPLICATION WHETHER ORAL, WRITTEN, OR THROUGH FAX MACHINE IS CORRECT TO THE BEST OF YOUR KNOWLEDGE. THE CREDIT UNION IS AUTHORIZED TO INVESTIGATE YOUR CREDIT-WORTHINESS, EMPLOYMENT HISTORY, AND TO OBTAIN A CREDIT REPORT AND TO ANSWER QUESTIONS ABOUT THEIR CREDIT EXPERIENCE WITH YOU. YOU UNDERSTAND THAT ANY FALSE OR MISLEADING STATEMENTS IN YOUR APPLICATION MAY CAUSE ANY LOAN OR EXTENSION TO BE IN DEFAULT. YOU UNDERSTAND THAT 18 U.S.C. §1014 MAKES IT A FEDERAL CRIME TO KNOWINGLY MAKE ANY FALSE STATEMENT ON THIS APPLICATION.
The USA Patriot Act requires that we verify the identity of all account holders. We may ask you or your co-applicant to show proof of your identity.
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| X |
__________________________________________ |
X |
__________________________________________ |
| |
APPLICANT SIGNATURE |
|
CO-APPLICANT SIGNATURE |
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| CREDIT COMMITTEE/LOAN OFFICER ACTION |
| Loan Officer: |
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Approved |
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Referred to C.C. |
Reason |
__________________________________________________ |
|
| LO Signature |
________________________________________________ |
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| Credit Committee: |
Date |
_____________________ |
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Approved |
|
Rejected |
Signature |
_______________________________ |
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| Outside information considered |
|
No |
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Yes |
(describe)_______________________________________________ |
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| Line of Credit Limit $ |
________________________ |
Conditions, if any: |
___________________________________________ |
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| Signed |
________________________________________________ |
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| Signed |
________________________________________________ |
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| Signed |
________________________________________________ |
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ECOA notice and Reasons for Rejection sent or delivered on ___________________________________________ |
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| Signed |
________________________________________________ |
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You Must Print, Sign, and Return to Credit Union
or apply by phone at 770-382-7373 or 770-383-3176
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