Loan Application

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* Required Fields

Purpose of Loan:

Account Number:

Amount Requested:

Applying for Joint Credit:

Yes

No

This application initiates the loan process. Final signature(s) will be required to advance funds, including signatures for joint applicants. We will contact you on or before the next business day after your application is received.

PRIMARY BORROWER INFORMATION (Note: enter name and skip to income information if existing member)

Full Name:

Street Address:

City:

State:

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Zip:

Years There:

Phone:

Driver's License Number:

Driver's License State:

Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Social Security Number:

Birth Date:

E-Mail Address:

INCOME INFORMATION (PRIMARY BORROWER)

Current Employer:

Years There:

Employer Phone Number:

Position:

Net Monthly Income:

Note: alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

List Other Income (Source and Net Monthly Amount):

CO-BORROWER INFORMATION (Note: enter name and skip to income information if existing member)

Full Name:

Street Address:

City:

State:

Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip:

Years There:

Phone:

Driver's License Number:

Driver's License State:

Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Social Security Number:

Birth Date:

E-Mail Address:

INCOME INFORMATION (CO-BORROWER)

Current Employer:

Years There:

Phone Number:

Position:

Net Monthly Income:

Note: alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other Income (Source and Monthly Amount):

ADDITIONAL INFORMATION (PRIMARY BORROWER)

Do you own or rent?

Own

Rent

If so, enter amount and current mortgage holder:

Amount you pay in alimony or child support:

Are you a Co-Borrower on any other loans?

Yes

No

How did you hear about us?

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Current member referral

Mailer

Other

Please enter mailer promo code, referring member, or other reason here:

Security:

Security Code

AGREEMENT

DISCLAIMER: I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION. WE UNDERSTAND THAT FEDERAL LAW REQUIRES THE VERIFICATION OF IDENTIFICATION FOR ALL NEW ACCOUNTS SHOULD I NOT HAVE AN EXISTING ACCOUNT. I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION AND PROPER IDENTIFICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US.

I accept the terms of the disclaimer above and submit my application.

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