Applicant Information:

Name:*
Account Number:
E-mail address:*
Phone:*
Social Security #:*
Driver's License Number:
Birth Date:
Present Address
City
State
Zip
How many years have you
lived at your current address?
Do you rent or own? Rent Own Live with relatives
Current Employer:
Employer's Phone:
Date Started:
Job Position/Title:
Est. Monthly Salary(gross): $
Do you own any property?

If yes, describe it and its value, also any leins on the property:

Do you own any Vehicles?

If yes, describe them and their value, also list any leins on the vehicles:

Are you a U.S. Citizen? No Yes
Do you have any outstanding judgements or have ever filed for bankruptcy? No Yes
Please list 2 references:  
Name: Phone: Address:
Name: Phone: Address:
   

Co-Applicant Information

Name:
Cu Account #(If any):
Social Security #:
Birth Date:
Current Employer:
Employer's Phone:
Date Started:
Job Position/Title:
Est. Monthly Salary(gross): $
Are you a U.S. Citizen? No Yes
Do you have any outstanding judgements or have ever filed for bankruptcy? No Yes
   

Loan Information

Type of Loan:*
How many years to pay this back?
Amount Requested:* $
Would you like credit disability insurance on your loan? No Yes
Would you like credit life insurance on your loan? No Yes
If a vehicle loan, please
describe the year, make,
model, VIN number, and
the dealership you are
purchasing from.
   

Debts

Debtor

Current Balance

Monthly Payment

Consolidate Into New Loan?

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Are you a co-maker, co-signer, or guarantor, on any loan not listed above? If yes for whom and to?

For: To:

If you have any other information you would like us to consider, or any comments or suggestions, please enter them  here:

*Required fields.

By submitting this form You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. You understand that the Credit Union will rely on the information in this application and your credit reports to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

 

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