Consumer Loan Application Page 1


TYPE OF ACCOUNT REQUESTED

Individual.

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.


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

APPLICANT INFORMATION

Applicant's Full Name
 
Member Number (if applicable)
Social Security #
Date of Birth
Driver's License #
State
Physical Address: Street
City, State
Zip
Time At This Address
Mailing Address if Different: Street
City, State
Zip
Own/Rent
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   
  
Borrower's Present Employer
If Self-Employed or Commissioned, Please Submit Full Copies of Last Two Years Income Tax Returns.
Gross Monthly Income $    Hired Date:
Employer Address
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.

CO-APPLICANT INFORMATION

Co-Applicant's Full Name
 
Member Number
Social Security #
Date of Birth
Driver's License #
State
Physical Address: Street

City, State
Zip
Time At This Address
Mailing Address if Different: Street
City, State
Zip
Own/Rent
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
    
CoBorrower's Present Employer
If Self-Employed or Commissioned, Please Submit Full Copies of Last Two Years Income Tax Returns.
Gross Monthly Income $     Hired Date:
Employer Address
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
Address
Phone
Relationship
Name
Address
Phone
Relationship