Loan Application

* indicates a required field



Loan Request Information
*Amount Requested $
Type of Loan
If you selected Personal Loan



Is this an individual or joint loan? Individual
Joint

Primary Borrower Information
*Name (First M. Last)
*Date of Birth (mm/dd/yyyy)
*Social Security Number
Account Number
Ages of Dependents #1   #2
#3   #4
#5   #6
Driver's License Number State
*E-mail
 
*Current Address
*City, State Zip ,
*Current Home Phone Number ( ) -
Former Address
City, State Zip ,
*Current Employer
*Current Job Title
*Current Work Address
*City, State ,
*Zip
*Current Work Phone Number ( ) -
*Hire Date
Complete former employment information if employed for less than 3 years at current employment:
Former Employer
Former Job Title
Employment Dates
Former Address
City, State ,
Zip

Co-Borrower Information
Name (First M. Last)
Date of Birth (mm/dd/yyyy)
Social Security Number
Ages of Dependents #1   #2
#3   #4
#5   #6
Driver's License Number State
E-mail
 
Current Address
City, State Zip ,
Current Home Phone Number ( ) -
Former Address
City, State Zip ,
Current Employer
Current Job Title
Current Work Address
City, State ,
Zip
Current Work Phone Number ( ) -
Hire Date
 
Former Employer
Former Job Title
Former Work Address
City, State ,
Zip

Monthly Income
  Borrower Co-Borrower
*Gross Income
Other Income
*Total:
Note: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan.

Income verification is required. A copy of your paycheck stub and co-applicants (if applicable) can be submitted by fax, mail, or in person.
 

Monthly Financial Obligations
  LIST CREDITORS NAME MONTHLY PAYMENT
*Rent/Mortgage:
 
Autos
 
Credit Cards
 
 
 
Others
 
 
*Total
 
Assets
  LIST NAMES VALUES
Checking Accounts
 
Savings Accounts
 
Real Estate
 
Investments
 
Autos
 
Other
 
Total Assets



Comments:
 
Other Questions
(Check box for 'yes' or leave blank for 'no')
If you answered "yes" to any questions explain in comment area.
Borrower
Are there any judgments against you?
Have you declared Bankruptcy within the past 7 years?
Have you had property foreclosed upon or given title/deed in lieu thereof in the last 7 years?
Are you a party to a law suit?
Are you obligated to pay alimony, child support, or separate maintenance?
Are you a co-maker or endorser on a note?
Are you a US Citizen or Permanent Resident Alien?
Co-Borrower
Are there any judgments against you?
Have you been declared bankrupt within the past 7 years?
Have you had property foreclosed upon or given title/deed in lieu thereof in the last 7 years?
Are you a party to a law suit?
Are you obligated to pay alimony, child support, or separate maintenance?
Are you a co-maker or endorser on a note?
Are you a US Citizen or Permanent Resident Alien?



I certify that statements on this application are true and complete.

I authorize any person, association, firm, or corporation to furnish, on request of this Credit Union, information concerning me or my affairs (Sec. 1014, Title 13, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application of a Federal Credit Union.

Additional documentation may be required. A Credit Union Representative will contact you.

* indicates a required field