Select Type of Loan
New Vehicle Loan
Used Vehicle Loan
Motorcycle Loan
Watercraft Loan
Share Pledged Loan
Certificate Pledged Loan
Open-end Personal Loan
Closed-end Personal Loan
Other
Member
Acct. No.:
Loan
amount:
List
the purpose of the loan. If this is a vehicle,
please list the year, make and model.
Credit
Life Insurance?
Yes
No
Credit
Disability Insurance?
Yes
No
Applicant
First
Name, Middle Initial, and Last Name
Residence
Address:
City:
State:
Zip:
Time
at Current Address
Years
Months
Home
Phone:
Work
Phone:
E-Mail
Address
Date
of Birth:
Social
Security Number:
Number
of Dependents
Name
of Employer
Length
of Employment
Years
Months
Gross
pay:
Hourly
Annually
Source
of Other Income(If applicable):You need not disclose the following
sources of income: Alimony, Child Support, or Maintenance unless
you want the credit union to consider such income in connection
with this loan application.
Monthly
Amount:
Co-Applicant:
Please include data about co-applicant if application is for joint
credit with a co-applicant, or if applicant will rely on co-applicant's
income.
First
Name, Middle Initial, and Last Name:
Street
address if different from applicant:
City:
State:
Zip:
Date
of Birth:
Social
Security Number:
Home
Phone:
Work
Phone:
Time
at Current Address:
Years
Months
Employed
by:
Length
of Employment
Years
Months
Gross
pay:
Hourly
Annually
Source
of Other Income(If applicable):You need not disclose the following
sources of income: Alimony, Child Support, or Maintenance unless
you want the credit union to consider such income in connection
with this loan application.
Monthly
Amount:
HOME
AND AUTO
Home:
Own
Buying
Rent
Landlord
or mortgage holder:
Value:
Mortgage
Balance if buying:
Monthly
Payment:
Auto
Loan financed with:
Balance:
Monthly
Payment:
Second
Auto Loan financed with:
Balance:
Monthly
Payment:
Insurance
Agent on home and car:
Credit
Cards or Unsecured Loans
Creditor:
Balance:
Monthly
payment:
Creditor:
Balance:
Monthly
payment:
Creditor:
Balance:
Monthly
payment:
Creditor:
Balance:
Monthly
payment:
Are
you a co-signer on any other loans?
Yes
No
Do
you pay alimony, child support or maintenance payments:
Yes
No
If
so, monthly payment:
Any
legal proceedings against you?
Yes
No
Have
you ever filed bankruptcy?
Yes
No
If
Yes, When:
Reason:
I/We
swear or affirm, UNDER THE PENALTIES OF PERJURY, that all information
contained on this application is true and accurate. I/We further
swear or affirm that the statement of debts contained in this
application is true, accurate, and a complete listing of all my/our
debts and obligations. This application is presented to induce
the credit union to extend credit to me/us on my/our behalf.
I/We
authorize you to check my/our credit and employment history from
time to time as you deem necessary and to answer questions from
others about your credit experience with me/us.
_________________________________
Applicant's Signature
_______________
Date
_________________________________
Co-Applicant's Signature
_______________
Date