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Getting Started
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Other
Amount Requested
Purpose of Loan
$
Type of Credit Requested
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
Primary Applicant
Personal Information
First Name
Last Name
M.I.
Social Security #
Birthdate (mm/dd/yyyy)
Home Phone
Email Address
Present Address
City
State
ZIP Code
Years at this address
Rent/Mortgage Payment
$
Own
Rent
With Relatives
Other
Number of Dependents
List Ages (separated by a comma, example: 8, 10, 14)
Landlord's Name
Landlord's Phone
Primary Applicant Previous Addresses (Back 3 years - Street, City, State, ZIP)
Address 1
Years?
Address 2
Years?
Address 3
Years?
Primary Applicant Employment/Income
Employer
Position
Work Phone
Employer's Address
City
State
ZIP Code
Gross Monthly Income
Start Date (mm/dd/yyyy)
$
Other Income per Month
Source
$
Income derived from alimony, child support, or separate maintenance payment need not be revealed if the applicant does not want the creditor to consider the information in determining the applicant’s creditworthiness.
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)
Primary Applicant References
Name and Address of Financial Institution
Checking Account #
1st Reference
Name of relative not living with you
Relationship
Home Phone
Relative's Address
2nd Reference
Name of relative not living with you
Relationship
Home Phone
Relative's Address
Primary Applicant Assets
Automobile Year
Automobile Make and Model
Financed By
Balance Owed
Monthly Payment
$
$
If you have a second Automobile please fill out the following:
Automobile Year
Automobile Make and Model
Financed By
Balance Owed
Monthly Payment
$
$
Co-Applicant
Personal Information
$
Co-Applicant Previous Addresses (Back 3 years - Street, City, State, ZIP)
Co-Applicant Employment/Income
$
$
Income derived from alimony, child support, or separate maintenance payment need not be revealed if the applicant does not want the creditor to consider the information in determining the applicant’s creditworthiness.
If employed in current position less than three years, complete the following
Co-Applicant References
1st Reference
2nd Reference
These Questions Apply to both Applicant and Co-Applicant
Applicant
Co-Applicant
Do you have any outstanding judgments?
Yes
No
In the last 10 years, have you been declared bankrupt or filed a petition for Chapter 13?
Yes
No
Have you had property foreclosed upon or given title or deed in lieu thereof, in the last 7 years?
Yes
No
Are you party in a lawsuit?
Yes
No
Are you a U.S. citizen or permanent resident alien?
Yes
No
Is your income likely to reduce in the next two years?
Yes
No
Are you a co-maker or co-signer on any loan?
Yes
No
For whom? (Name of others obligated on loan)
To whom? (Name of creditor)
Finishing Up
Best Way to Contact (enter phone number or email address)
Comments and/or Event Code (if applicable)
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
Please solve this simple equation so we know you're a real person:
Is eight = five ? (true/false)