Loan Application

(*) denotes required fields

 *Purpose of Loan:                 Term:

*Collateral Description:

*Account Number:
*Amount Requested

This application initiates the loan process.  Final signature(s) will be required to advance funds.

PLEASE TELL US ABOUT YOURSELF (PRIMARY BORROWER)
*Full Name
*Street Address
*City, State  Zip
*Years There
*Home Phone
*Cell Phone Number
*Driver's License State/Number:   
*Social Security Number
*Birth Date
*E-Mail Address
PLEASE TELL US ABOUT YOUR JOB (PRIMARY BORROWER)
Current Employer
Years There
Phone Number
Position
Gross Monthly Income
alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation
Gross Monthly


Alimony


Child Support


Other

Other Income
Source
PLEASE LIST NEAREST RELATIVE NOT LIVING WITH YOU
*Full Name
*Home Address
*City, State  Zip
*Birth Date
*Phone Number
The following information pertains to CO-BORROWER.
If there is not a CO-BORROWER, click here to continue.
PLEASE TELL US ABOUT YOURSELF (CO-BORROWER)
Full Name
Home Address
City, State  Zip
Years There
Home Phone
Social Security Number
Birth Date
PLEASE TELL US ABOUT YOUR JOB (CO-BORROWER)
Current Employer
Years There
Phone Number
Position
Gross Monthly Income
alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation
Gross Monthly


Alimony


Child Support


Other

Other Income
Source
IF THERE IS A CO-BORROWER, PLEASE LIST NEAREST RELATIVE NOT LIVING WITH YOU (CO-BORROWER)
*Full Name
*Home Address
*City, State  Zip
*Birth Date
*Phone Number
IF APPLYING FOR A PERSONAL UNSECURED LOAN SUCH AS VACATION OR OTHER
PLEASE SUPPLY ALL INFORMATION REQUESTED BELOW.
MONTHLY PAYMENTS
Debt Payments Payment to Monthly Payment Balance Owed
Mortgage  or
Rent
Auto:

Charge Card(s) or other Creditors?

Are you liable for alimony, child support, or separate maintenance payments? Alimony: Yes No
If yes, amount paid per month

Child Support: Yes No
If yes, amount paid per month
Are you a Co-Borrower on any other loans?  Yes No
For Whom: Where:
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.


Signature: _________________________________Date: _______________________