TYPE AND AMOUNT OF CREDIT YOU'RE
REQUESTING
  Is this your first loan from us? yes no
  Amount/Credit Limit Requested: $
  Approximate Time to Repay: How Many?
Periods:
  Loan Type:
  Security Offered:
(for secured credit only)
  Type of Credit: Individual Joint

PAYMENT PROTECTION COVERAGE

 

 

Find out more about Credit Life Protection and Credit Disability Protection and why it's a better consumer value when offered through your credit union.

Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
  Yes
No 		Do you want your loan protected for you and your family if you become disabled?
  Yes
No 		Do you want your loan protected for you and your family in the event of your death?
 

TELL US ABOUT YOURSELF

Applicant

Name:
CU Account #:
Social Security #:
Date of Birth: (mm/dd/yyyy)

Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married    Separated    Unmarried (Single — Divorced — Widowed)
Home Phone:
Cell Phone:
Business Phone:
Mailing Address:
Physical Address: (if different from mailing address)
Years There:   Own Rent
Previous Address: (if at current address less than 2 years)
Applicant - Debts
Mortgage/Rent owed to:
Balance (Mortgage only):
Monthly Payment:
Applicant - Income
Employer:
Current Position Held:
List other employers, position and length of employment.
Income:
$

Net Gross
Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.) Source:
 
$

Annual Monthly Hourly

   
Co-Applicant
Name:
CU Account #:
Date of Birth: (mm/dd/yyyy)
Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married Separated Unmarried
(Single - Divorced - Widowed)
Home Phone:
Cell Phone:
Business Phone:
Present Address:
  
Years There:   Own     Rent
Co-Applicant - Debts
Mortgage/Rent owed to:
Balance (Mortgage only):
Monthly Payment:
Co-Applicant - Income
Employer: Add length of employment and position held.
Current Position Held:
List other employers, position and length of employment.
Income: $ Net Gross
Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony,child support or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.) Source:
$ 

Annual Monthly Hourly
 

SIGNATURES:

X________________________________
Applicant Signature and Date

 
X________________________________
Co-Applicant Signature and Date

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment. You understand that we will retain this application whether or not the loan is approved.

You authorize the credit union to obtain credit reports in connection with this request.

 
Please complete and print this application, sign the printed application and fax, mail or hand-carry it to the branch of your choice.
Find your branch address here.