Loan Application

Getting Started

Member Non-Member
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	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
	$	$

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
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