Loan Application

Getting Started
Amount Requested	Purpose of Loan
$

Personal Information - Primary Applicant
First Name	Last Name	M.I.

SSN	Email Address

Birthdate (mm/dd/yyyy)	Home Phone	Cell Phone
	() -Second partThird part	() -Second partThird part
Present Address	City	State

ZIP Code	Years at this address	Rent/Mortgage Payment
		$
OwnRentWith RelativesOther

Personal Information - Joint Applicant
Type of Applicant
Co-ApplicantSpouseGuarantor
First Name	Last Name	M.I.

SSN	Email Address

Birthdate (mm/dd/yyyy)	Home Phone	Cell Phone
	() -Second partThird part	() -Second partThird part
Present Address	City	State

ZIP Code	Years at this address	Rent/Mortgage Payment
		$
OwnRentWith RelativesOther

Previous Address - Primary Applicant
Address 1	Years?

Address 2	Years?

Address 3	Years?

Previous Address - Joint Applicant
Address 1	Years?

Address 2	Years?

Address 3	Years?

Employment/Income - Primary Applicant
Employer	Work Phone
	() -Second partThird part
Employer's Address	City	State

ZIP Code	Gross Monthly Income	Start Date (mm/dd/yyyy)
	$
Other Income per Month	Source
$
If employed in current position less than three years, complete the following
Previous Employer	Previous Employer's Address

Start Date (mm/dd/yyyy)	End Date (mm/dd/yyyy)

Employment/Income - Joint Applicant
Employer	Work Phone
	() -Second partThird part
Employer's Address	City	State

ZIP Code	Gross Monthly Income	Start Date (mm/dd/yyyy)
	$
Other Income per Month	Source
$
If employed in current position less than three years, complete the following
Previous Employer	Previous Employer's Address

Start Date (mm/dd/yyyy)	End Date (mm/dd/yyyy)

References - Primary Applicant
Name and Address of Depository		Checking Account #

Name of relative not living with you	Relationship	Home Phone
		() -Second partThird part
Relative's Address

Name of a personal friend - not a relative	Relationship	Home Phone
		() -Second partThird part
Friend's Address

References - Joint Applicant
Name and Address of Depository		Checking Account #

Name of a relative not living with you	Relationship	Home Phone
		() -Second partThird part
Relative's Address

Name of a personal friend - not a relative	Relationship	Home Phone
		() -Second partThird part
Friend's Address

These Questions Apply to both Applicant and Co-Applicant
	Applicant	Co-Applicant
Have you any outstanding Judgement?	YesNo	YesNo
In the last 10 years, have you been declared bankrupt or filed a petition for Chapter 13?	YesNo	YesNo
Have you had property foreclosed upon or given title or deed in lieu thereof, in the last 7 years?	YesNo	YesNo
Are you party in a lawsuit?	YesNo	YesNo
Are you other than a U.S. citizen or permanent resident alien?	YesNo	YesNo
Is your income likely to reduce in the next two years?	YesNo	YesNo
Are you a co-maker or co-signer on any loan?	YesNo	YesNo
For whom? (Name of others obligated on loan)
To whom? (Name of creditor)

Type of Credit Requested
IMPORTANT: Check the appropriate boxes and complete the applicable sections:
Type of Credit Requested
SecuredUnsecured
If Secured:
Year	Make	Model

VIN	Mileage

Options

Individual Credit: Relying solely on my income or assets Individual Credit: Relying on my income or assets as well as income or assets from other sources Joint Credit: We intend to apply for joint credit

Finishing Up
Contact Method

Comments

Loan Promo Code

User Agreement
Everything that I have stated in this application is correct to the best of my knowledge. The Credit Union is authorized to check my credit, employment history, obtain a credit report and to answer questions about their credit experience with me. I understand that it may be a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of the United States Criminal Code.
I have read and accept the terms
Account Disclosures
Click here to view the Account Disclosures.
I have read, understand and agree to the terms of application.
E-Sign Act Disclosure
Click here to view the E-Sign disclosure.
I have read, understand and agree to the E-Sign Act.

Primary Signature

Joint Signature

Date (mm/dd/yyyy)

Please enter the security code below prior to submitting the form

Security code