Loan Application

Getting Started
	Amount Requested	Purpose of Loan
MemberNon-Member
	$
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
	() -Second partThird part
Present Address	City	State	ZIP Code

Years at this address	Rent/Mortgage Payment
	$
OwnRentWith RelativesOther
Number of Dependents	List Ages (separated by a comma, example: 8, 10, 14)

Landlord's Name	Landlord's Phone
	() -Second partThird part

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
		() -Second partThird part
Employer's Address	City	State	ZIP Code

Gross Monthly Income	Start Date (mm/dd/yyyy)
$
Other Income per Month	Source
$
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
		() -Second partThird part
Relative's Address

2nd Reference
Name of relative not living with you	Relationship	Home Phone
		() -Second partThird part
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





$

$
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?	YesNo
In the last 10 years, have you been declared bankrupt or filed a petition for Chapter 13?	YesNo
Have you had property foreclosed upon or given title or deed in lieu thereof, in the last 7 years?	YesNo
Are you party in a lawsuit?	YesNo
Are you a U.S. citizen or permanent resident alien?	YesNo
Is your income likely to reduce in the next two years?	YesNo
Are you a co-maker or co-signer on any loan?	YesNo
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

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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