Loan Application

Members who have an OPEN-END LOAN established with us need only to complete *required fields when requesting advance.

* Required Field

* Purpose of Loan

* Term

* Account Number

* Amount Requested

Please Tell Us About Yourself (Primary Borrower)

* Full Name

* Street Address

* City

* State

* Zip Code

* Years There

* Home Phone

() -

Work Phone

() -

* Diver's License

* Driver's License State

* Social Security Number

- -

* Birth Date

/ / (mm/dd/yyyy)

* Email Address

Please Tell Us About Your Job (Primary Borrower)

Current Employer

Years There

Phone Number

Position

Gross Monthly Salary/Hourly Income

Monthly dollar amount that you receive in alimony, child support, or separate maintenance - this income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other Income

Source

The following information pertains to CO-BORROWER.

Please Tell Us About Yourself (Co-Borrower)

Full Name

Street Address

City

State

Zip Code

Years There

Home Phone

() -

Work Phone

() -

Social Security Number

- -

Birth Date

/ / (mm/dd/yyyy)

Please Tell Us About Your Job (Co-Borrower)

Current Employer

Years There

Phone Number

Position

Gross Monthly Salary/Hourly Income

Other Income

Source

Please List Nearest Relative Not Living With You

* Full Name

* Home Address

* City, State, Zip

* Primary Phone Number

If applying for a personal secured loan such as vacation or other, please select a form of collateral

* Collateral

Monthly Payments

	Payment To	Monthly Payment	Balance Owed
Mortgage or Rent
Auto
Credit Card

Other Monthly Payments

	Payment for	Payment to	Monthly Payment	Balance Owed
1.
2.
3.

Alimony/Child Support (monthly)

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

Are you a Co-borrower on any other loans?

Yes
No

If yes, for whom

Where

Monthly Payment

Click the "Submit 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.

Applicant Signature: ______________________________________________________
Date: ____________________

Co-applicant Signature: ______________________________________________________
Date: ____________________
Co-applicant: By signing this document, I am expressing my affirmative consent to become a joint applicant