Loan Application * Required Fields Purpose of Loan: Term: Select... 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 10 Years 15 Years Account Number: Amount Requested: Applying With a Co-Borrower? Yes No This application initiates the loan process. Final signature(s) will be required to advance funds, including signatures for joint applicants. PLEASE TELL US ABOUT YOURSELF (PRIMARY BORROWER) 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: Home Phone: Work 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: PLEASE TELL US ABOUT YOUR JOB (PRIMARY BORROWER) Current Employer: Years There: Phone Number: Position: Gross Montly 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: PLEASE TELL US ABOUT YOURSELF (CO-BORROWER) 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: Home Phone: Work 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: PLEASE TELL US ABOUT YOUR JOB (CO-BORROWER) Current Employer: Years There: Phone Number: Position: Gross Montly 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: PLEASE LIST NEAREST RELATIVE NOT LIVING WITH YOU Full Name: Home 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: Phone Number: Monthly Payments Mortgage Payments to: Monthly Payment: Balance Owed: Rent Payment to: Monthly Payment: Balance Owed: Auto Payment to: Monthly Payment: Balance Owed: Auto 2 Payment to: Monthly Payment: Balance Owed: Charge Card Payment to: Monthly Payment: Balance Owed: Other Payment to: Monthly Payment: Balance Owed: Other Payment to: Monthly Payment: Balance Owed: Other Payment to: Monthly Payment: Balance Owed: Amount you pay in alimony or child support: Are you a Co-Borrower on any other loans? Yes No Where: Monthly Payment: 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. Security Code: Security Code Go to main navigation
