Loan Application

* Required Fields

Best Time to Call You:

Best Phone # To Reach You:

Purpose of Loan:

Collateral:

Term:

Account Number:

Amount Requested:

Down Payment/Trade-in/Cash:

Credit Life

Credit Disability

Payroll Deduction

Application Type:

Individual

Joint

Please Tell Us About Yourself (Primary Borrower)

Full Name:

Street Address:

Street Address 2:

City:

State:

ZIP:

Years There:

Home Value:

Own

Buying

Renting

Your Vehicles

Vehicle 1 Year:

Vehicle 1 Make:

Vehicle 1 Model:

Vehicles 2 Year:

Vehicles 2 Make:

Vehicle 2 Model:

Other Property Owned:

Have you ever filed Bankruptcy?

Yes

No

Date, if yes:

Are you a co-maker on other loans:

Yes

No

If so, for whom?

How much?

Home Phone:

Work Phone:

Cell Phone:

Social Security Number:

- -

Birth Date:

/ /

Email Address:

Please Tell Us About Your Job (Primary Borrower)

Current Employer:

Years There:

Phone Number:

Position:

Gross Monthly Salary/Hourly Income:

Monthly dollar amount that you receive in alimony, child support, or separate maintenance - this income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other Income:

Source:

The following information pertains to CO-BORROWER.

Please Tell Us About Yourself (Co-Borrower)

Full Name:

Street Address:

Street Address 2:

City:

State:

ZIP:

Years There:

Home Phone:

Work Phone:

Cell Phone:

Social Security Number:

- -

Birth Date:

/ /

Email Address:

Your Vehicles

Vehicle 1 Year:

Vehicle 1 Model:

Vehicle 1 Make:

Vehicle 2 Year:

Vehicle 2 Model:

Vehicle 2 Make:

Other Property Owned:

Please Tell Us About Your Job (Co-Borrower)

Current Employer:

Years There:

Phone Number:

Position:

Gross Monthly Salary/Hourly Income:

Monthly dollar amount that you receive in alimony, child support, or separate maintenance - this income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other Income:

Source:

Please List Nearest Relative Not Living With You

Full Name:

Home Address:

Home Address 2:

City:

State:

ZIP:

Primary Phone Number:

Please List An Additional Relative Not Living With You

Full Name:

Home Address:

Home Address 2:

City:

State:

ZIP:

Primary Phone Number:

Statement of Total Indebtedness and Liabilities

Mortgage or Rent

Owed To:

Security:

Balance Owed:

Monthly Payment:

Landlord's Address:

Landlord's Phone #:

Auto Loan

Owed To:

Security:

Balance Owed:

Monthly Payment:

Credit Union

Owed To:

Security:

Balance Owed:

Monthly Payment:

Bank

Owed To:

Security:

Balance Owed:

Monthly Payment:

Credit Card

Owed To:

Security:

Balance Owed:

Monthly Payment:

Credit Card

Owed To:

Security:

Balance Owed:

Monthly Payment:

Other

Owed To:

Security:

Balance Owed:

Monthly Payment:

Child Support / Alimony / Separate Maintenance

Owed To:

Security:

Balance Owed:

Monthly Payment:

Click the "I accept the terms of the disclaimer above and submit my application" button to send the application to us via the WWW after reading the disclaimer below. By clicking "I accept the terms of the disclaimer above and submit my application", you accept the terms of the disclaimer below.

DISCLAIMER: I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION. I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US.

Applicant Signature: _________________________________

Date: ____________________

Co-applicant Signature: _______________________________

Date: ____________________

Security Code (What's this?):

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Routing Number: 272478350

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