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(*)

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Date(*)

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CONSUMER LOAN TYPE

Purpose of Loan

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Limit $

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Collateral Secured

Requested Amount: $

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Requested Term

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Collateral Offered

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Owned By

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MARRIED APPLICANTS MAY APPLY FOR INDIVIDUAL ACCOUNTS, INDICATE BELOW THE TYPE OF CREDIT WANTED

Type of Application(*)

Individual credit
Joint Credit

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

Applicant Marital Status(*)

Married Separated Unmarried (Single, Divorced, Widowed)

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APPLICANT

First Name(*)

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Initial

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Last Name(*)

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Home Phone(*)

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Social Security No.(*)

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Drivers License No & State(*)

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Birth Date(*)

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No. of Dependents

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Ages

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Current Street Address(*)

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Apt. No.

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Years There

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City(*)

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State(*)

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Zip Code(*)

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Former Street Address

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Apt. No.

Invalid Input

Years There

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City

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State

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Zip Code

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

Current Employer

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Hire Date

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Street Address

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City

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State

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Zip

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Phone

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Position

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Monthly Gross Income

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Supervisor's Name & Phone Number

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Former Employer - Name/Address/Phone

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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

Invalid Input

Phone

Invalid Input

Monthly Income

Invalid Input

Source of Other Income 2

Invalid Input

Phone

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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
Invalid Input	Invalid Input	Invalid Input	Invalid Input
Invalid Input	Invalid Input	Invalid Input	Invalid Input

ASSETS AND DEPOSITS List all assets

Checking

Financial Institution

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Approx. Balance

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Savings

Financial Institution

Invalid Input

Approx. Balance

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IRA'S

Financial Institution

Invalid Input

Approx. Balance

Invalid Input

Automobiles

Car 1: Year/Make

Invalid Input

Value:

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Car 2: Year/Make

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Value:

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Realestate

Real Estate

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Value:

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Other

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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	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	Invalid Input	Invalid Input	Invalid Input	Invalid Input

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

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

Yes No

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If yes, Date:

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

Yes No

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If yes, Date:

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

Yes No

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For Whom?

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Where?

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Do you have any past due bills?(*)

Yes No

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Is any income you have listed likely to reduce in the next two years?

Yes No Invalid Input

Have you ever had credit in any other name?

Yes No Invalid Input

What Name?

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Have you any suits pending, judgements filed, alimony or support awards against you?

Yes No Invalid Input

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

Yes No Invalid Input

MARRIED CO-APPLICANTS MAY APPLY FOR INDIVIDUAL ACCOUNTS, INDICATE BELOW THE TYPE OF CREDIT WANTED

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

Married Separated Unmarried (Single, Divorced, Widowed) Invalid Input

CO-APPLICANT

First Name

Invalid Input

Initial

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Last Name

Invalid Input

Home Phone

Invalid Input

Social Security Number

Invalid Input

Drivers License No & State

Invalid Input

Birth Date

Invalid Input

No. of Dependents

Invalid Input

Ages

Invalid Input

Current Street Address

Invalid Input

Apt. No.

Invalid Input

Years There

Invalid Input

City

Invalid Input

State

Invalid Input

Zip Code

Invalid Input

Former Stree Address

Invalid Input

Apt. No.

Invalid Input

Years There

Invalid Input

City

Invalid Input

State

Invalid Input

Zip Code

Invalid Input

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

Current Employer

Invalid Input

Hire Date

Invalid Input

Street Address

Invalid Input

City

Invalid Input

State

Invalid Input

Zip

Invalid Input

Phone

Invalid Input

Position

Invalid Input

Monthly Gross Income

Invalid Input

Supervisor's Name & Phone Number

Invalid Input

Former Employer - Name/Address/Phone

Invalid Input

Years There

Invalid Input

CO-APPLICANT 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

Invalid Input

Phone

Invalid Input

Monthly Income

Invalid Input

Source of Other Income 2

Invalid Input

Phone

Invalid Input

Monthly Income

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

Checking

Financial Institution

Invalid Input

Approx. Balance

Invalid Input

Savings

Financial Institution

Invalid Input

Approx. Balance

Invalid Input

IRA'S

Financial Institution

Invalid Input

Approx. Balance

Invalid Input

Car 1: Year/Make

Invalid Input

Value:

Invalid Input

Car 2: Year/Make

Invalid Input

Value:

Invalid Input

Real Estate

Invalid Input

Value:

Invalid Input

Other

Invalid Input

Value:

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	Invalid Input	Invalid Input	Invalid Input	Invalid Input

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

Have you ever filed a petition for bankruptcy?

Yes No Invalid Input

If yes, Date:

Invalid Input

Have you ever had any auto, furniture or property repossessed?

Yes No Invalid Input

If yes, Date:

Invalid Input

Are you a co-maker or guarantor of any loan or lease?

Yes No Invalid Input

For Whom?

Invalid Input

Where?

Invalid Input

Do you have any past due bills?

Yes No Invalid Input

Is any income you have listed likely to reduce in the next two years?

Yes No Invalid Input

Have you ever had credit in any other name?

Yes No Invalid Input

What Name?

Invalid Input

Have you any suits pending, judgements filed, alimony or support awards against you?

Yes No Invalid Input

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

Yes No Invalid Input

You agree that everything stated in this application whether oral, written or through a fax machine, is true and correct to the best of your knowledge. The Credit Union or its agent is authorized to investigate your credit worthiness, employment history, and to obtain a credit report and to answer questions about their credit history with you. You understand that any false or misleading statements in your application may cause any loan to be in default. You agree that this application shall be the Credit Union's property whether or not this Credit Application is approved. You agree to fully insure any collateral offered against loss and damage. You may obtain this insurance through any insurance company of your choice, unless the Credit Union, for good cause, refuses to accept it. NOTICE: Consumer reports (credit reports) may be obtained in connection with this application. If you request, 1) You will be informed whether or not consumer reports were obtained; and 2) If reports were obtained, you will be informed of the names and addresses of the consumer reporting agencies (credit bureaus) that furnished the reports.

Applicant Signature

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Date

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Applicant E-mail:(*)

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Co-Applicant Signature

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Date

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