Consumer Loan Application

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Submit this application today via our secured server, or stop by the credit union for more information. You may also print out this application and mail it or fax it in for processing.

You'll be glad you did.
Notice: Married Applicants may apply for a separate account. Check the appropriate box below to indicate the type of credit for which you are applying.

APPLICANT ACCOUNT NUMBER (*)
Date (*)
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CONSUMER LOAN TYPE

Purpose of Loan
Limit $
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Collateral Secured

Requested Amount: $
Requested Term
Collateral Offered
Owned By
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MARRIED APPLICANTS MAY APPLY FOR INDIVIDUAL ACCOUNTS, INDICATE BELOW THE TYPE OF CREDIT WANTED

Type of Application(*)

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Applicant: Complete for secured credit or if you live in a community property state

Applicant Marital Status(*)
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APPLICANT

First Name(*)
Initial
Last Name(*)
Home Phone(*)
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Social Security No.(*)
Drivers License No & State(*)
Birth Date(*)
No. of Dependents
Ages
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Current Street Address(*)
Apt. No.
Years There
City(*)
State(*)
Zip Code(*)
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Former Street Address
Apt. No.
Years There
City
State
Zip Code
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EMPLOYMENT AND INCOME If self employed, attach financial statement and income tax return.

Current Employer
Street Address
City
State
Zip
Phone
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Position
Monthly Gross Income
Hire Date
Supervisor's Name & Phone Number
Former Employer - Name/Address/Phone
Years There
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OTHER INCOME You need not list income from alimony, child support, or separate maintenance unless you wish it considered for purposes of granting this credit.

Source of Other Income 1
Phone
Monthly Income
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Source of Other Income 2
Phone
Monthly Income
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APPLICANT PERSONAL REFERENCES

Nearest Relative Not Living With You - Name/Address/Phone
Relationship
Personal Reference (Not a Relative) - Name/Address/Phone
Known Since
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ASSETS AND DEPOSITS List all assets

Financial Institution
Approx. Balance
Checking

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Financial Institution
Approx. Balance
Savings

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Financial Institution
Approx. Balance
IRA'S

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Car 1: Year/Make
Value:
Car 2: Year/Make
Value:
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Real Estate
Value:
Other
Value:
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CREDIT INFORMATION Be sure to list all open accounts with or without a balance.

Type of Loan

Name of Creditor

Account No

Balance

Monthly Payments

Mortgage or Rent

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Second Mortgage

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Auto Loan

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Credit Card

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Credit Card

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Other

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Other

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Other

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Other

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Other

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Other

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Please answer the following questions. If a yes answer is given, explain on an attached sheet.

Have you ever filed a petition for bankruptcy?(*)
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If yes, Date:  Invalid Input

Have you ever had any auto, furniture or property repossessed?(*)
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If yes, Date:  Invalid Input

Are you a co-maker or guarantor of any loan or lease? (*)
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For Whom?    Invalid Input    Where?    Invalid Input  
Do you have any past due bills? (*)
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Is any income you have listed likely to reduce in the next two years?
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Have you ever had credit in any other name?
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What Name?  Invalid Input

Have you any suits pending, judgements filed, alimony or support awards against you?
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Are you other than a U.S. Citizen or resident alien?
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CO-APPLICANT ACCOUNT NUMBER(*)
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Co-Applicant: Complete for secured credit or if you live in a community property state

Co-Applicant Marital Status(*)
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First Name(*)
Initial
Last Name(*)
Home Phone(*)
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Invalid Input

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Social Security Number(*)
Drivers License No & State(*)
Birth Date(*)
No. of Dependents
Ages
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Invalid Input

Invalid Input

Invalid Input

Invalid Input

Current Street Address(*)
Apt. No.
Years There
City(*)
State(*)
Zip Code(*)
Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Former Stree Address
Apt. No.
Years There
City
State
Zip Code
Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

EMPLOYMENT AND INCOME If self employed, attach financial statement and income tax return.

Current Employer
Street Address
City
State
Zip
Phone
Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Position
Monthly Gross Income
Hire Date
Supervisor's Name & Phone Number
Former Employer - Name/Address/Phone
Years There
Invalid Input

Invalid Input

Invalid Input
Invalid Input

Invalid Input

Invalid Input

OTHER INCOME You need not list income from alimony, child support, or separate maintenance unless you wish it considered for purposes of granting this credit.

Source of Other Income 1
Phone
Monthly Income
Invalid Input

Invalid Input

Invalid Input

Source of Other Income 2
Phone
Monthly Income
Invalid Input

Invalid Input

Invalid Input

CO-APPLICANT PERSONAL REFERENCES

Nearest Relative Not Living With You - Name/Address/Phone
Relationship
Personal Reference (Not a Relative) - Name/Address/Phone
Known Since
Invalid Input


Invalid Input

Invalid Input


Invalid Input

Invalid Input


Invalid Input

Invalid Input


Invalid Input

CO-APPLICANT ASSETS AND DEPOSITS List all assets

Financial Institution
Approx. Balance
Checking

Invalid Input

Invalid Input

Financial Institution
Approx. Balance
Savings

Invalid Input

Invalid Input

Financial Institution
Approx. Balance
IRA'S

Invalid Input

Invalid Input

Car 1: Year/Make
Value:
Car 2: Year/Make
Value:
Invalid Input

Invalid Input

Invalid Input

Invalid Input

Real Estate
Value:
Other
Value:
Invalid Input

Invalid Input

Invalid Input

Invalid Input

CREDIT INFORMATION Be sure to list all open accounts with or without a balance.

Type of Loan

Name of Creditor

Account No

Balance

Monthly Payments

Mortgage or Rent

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Second Mortgage

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Auto Loan

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Credit Card

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Credit Card

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Other

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Other

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Other

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Other

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Other

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Other

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Invalid Input

Invalid Input

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Please answer the following questions. If a yes answer is given, explain on an attached sheet.

Have you ever filed a petition for bankruptcy?(*)
Invalid Input

If yes, Date:  Invalid Input

Have you ever had any auto, furniture or property repossessed?(*)
Invalid Input

If yes, Date:  Invalid Input

Are you a co-maker or guarantor of any loan or lease? (*)
Invalid Input

For Whom? (*)    Invalid Input    Where?    Invalid Input  
Do you have any past due bills? (*)
Invalid Input

Is any income you have listed likely to reduce in the next two years? (*)
Invalid Input

Have you ever had credit in any other name? (*)
Invalid Input

What Name? (*)  Invalid Input

Have you any suits pending, judgements filed, alimony or support awards against you? (*)
Invalid Input

Are you other than a U.S. Citizen or resident alien?
Invalid Input

Co-Applicant Signature
Date
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Applicant Signature
Date
Applicant E-mail: (*)
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Enter Security Code:(*)
Invalid Security Code Input

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