New Loan Application


TYPE OF ACCOUNT REQUESTED

Complete “Applicant “ Section if you are applying for an individual account in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested.

Complete all Sections if you are applying for an individual account, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, providing information in the Co-Applicant Section about the person on whose alimony, support, or maintenance payments or income of assets you are relying. If you reside in a community property state (AK, AZ, ID, LA, MN, NV, TX, WA, WI) or income is derived from a community property state, all Sections of the application should be completed.

Joint Complete all Sections if you are applying for a joint account or an account that you and another person will use.


TYPE OF LOAN REQUESTED

Choose one.
Consumer Loan
Line of Credit
Credit Card
Amount Requested:
Purpose of Loan:

APPLICANT INFORMATION

Applicant's Full Name (First, MI, Last)
 
Member Number (if applicable)
Social Security #
Date of Birth (mm/dd/yyyy)
Driver's License #
State
Physical Address (street, city, state & zip)
Time At This Address
Own/Rent
Mailing Address if Different than Physical Address
Home Phone
Work Phone
Cell Phone
Email Address
Please Indicate Marital Status If You Reside In a Community Property State: AZ, CA, ID, LA, NM, NV, TX, WA, WI
Married     
Separated     
Unmarried   
  

APPLICANT EMPLOYMENT INFORMATION

If Self-Employed or Commissioned, Please Submit Full Copies of Last Two Years Income Tax Returns.
Borrower's Present Employer
Gross Monthly Income
Hired Date:
Employer Address
Position
Additional Income Source:
Monthly Amount

Income from alimony, child support, or separate maintenance payments need not be revealed if you do not wish us to consider it.

PERSONAL REFERENCES

Name (First, Last)
Address
Phone
Relationship
Name (First, Last)
Address
Phone
Relationship

CO-APPLICANT INFORMATION

Co-Applicant's Full Name (First, MI, Last)
Member Number
Social Security #
Date of Birth
Driver's License #
State
Physical Address (street, city, state & zip)
Time At This Address
Own/Rent
Mailing Address if Different than Physical Address
Home Phone
Work Phone
Cell Phone
Email Address
Please Indicate Marital Status If You Reside In a Community Property State: AZ, CA, ID, LA, NM, NV, TX, WA, WI
Married
Separated
Unmarried

CO-APPLICANT EMPLOYMENT INFORMATION

If Self-Employed or Commissioned, Please Submit Full Copies of Last Two Years Income Tax Returns.
CoBorrower's Present Employer
Gross Monthly Income
Hired Date:
Employer Address
Position
Additional Income Source:
Monthly Amount
Income from alimony, child support, or separate maintenance payments need not be revealed if you do not wish us to consider it.

LIABILITIES

Loan Decision May Be Adversely Affected If All Debt Information is Not Listed.
Housing: Landlord/Mortage Co.

Property Taxes Included? Yes   No
Monthly Payment
Balance Owing
2nd Mortgage and/or Taxes
Monthly Payment
Balance Owing
Creditor
Monthly Payment
Balance Owing
Creditor
Monthly Payment
Balance Owing
Creditor
Monthly Payment
Balance Owing
Creditor
Monthly Payment
Balance Owing
Creditor
Monthly Payment
Balance Owing
Creditor
Monthly Payment
Balance Owing
Creditor
Monthly Payment
Balance Owing

LIABILITIES - CONTINUED

Are You A U.S. Citizen Or Permanent Resident Alien?
Applicant
Yes
No
Co-Applicant
Yes
No
In The Past 10 Yrs. Have You Filed a Bankruptcy Petition?
Applicant
Yes
No
Co-Applicant
Yes
No
Are You A Co-Maker, Co-Signer, Or Guarantor On Any Loan Not Listed Above?
Applicant
Yes
No
Co-Applicant
Yes
No
Creditor
Balance
Monthly Pmt.
Creditor
Balance
Monthly Pmt.
Have You Had Property Foreclosed Upon or Given Title or Deed In Lieu Thereof In The Last 7 Years?
Applicant
Yes
No
Co-Applicant
Yes
No
Have You Any Outstanding Judgments?
Applicant
Yes
No
Co-Applicant
Yes
No
Are You A Party In A Lawsuit?
Applicant
Yes
No
Co-Applicant
Yes
No
Is Your Income Likely To Reduce Over The Life Of This Loan Plan?
Applicant
Yes
No
Co-Applicant
Yes
No

CONSUMER LOAN APPLICATION SIGNATURES

By signing below, you certify that the information on this Application is complete, true, and submitted for the purpose of obtaining credit and you agree: (a) that the Credit Union can use credit reporting agencies or otherwise verify the information on this Application; (b) that the Credit Union can tell others about its credit experience with you and receive information from others about your credit history and performance; and (c) that you will give the Credit Union your new address if you move and that all notices and statements from the Credit Union may be sent to the address(es) shown on this Application or an address correction received from the U.S. Postal Service for any applicant or authorized user. Signature by two persons below indicates intent to apply for joint credit. If you are applying for a credit card, you agree that use of the card indicates your agreement to the Visa Credit Card Agreement and Disclosures. You also grant the Credit Union a security interest in all of your Credit Union share and deposits (except IRA accounts) to secure your credit card. If you are in default, we may apply the balance in your account(s) to amounts you owe at any time without notice.