Loan Request


Loan Request

Loan Information
Amount Requested:
Time to Repay:
         Periods:
Loan Type:
Security Offered (For secured credit only)
Type of Credit:
Individual Joint

Payment Protection Coverage
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.
• Do you want your loan protected for you and your family in the event you become disabled? Yes No
• Do you want your loan protected for you and your family in the event of your death? Yes No


Tell Us About Yourself And The Co-Applicant
Co-applicant information should be provided if:
• Your spouse will use the account.
• You are relying on your spouse's income as a basis of repayment,
• If you are relying on income from alimony, child support or separate maintenance income, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.
• If you are applying for Joint Credit with another person.
• You are living in or the property pledged as collateral is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA and WI).
Applicant
Your Name
Your Birth Date
Your Account Number #
Marital Status
Married    Unmarried    Separated
Social Security #
Drivers License #
DL State
Address
City, State Zip Code
,
Years at Address
Own or Rent
Own    Rent/Other
Work Phone
Home Phone
Mobile Phone
Email
Mortgage Owed To
Monthly Mortgage
Person Responsible for Mortgage
Mortgage Balance
Mortgage APR
Credit Card 1
Balance
Monthly Payment
Credit Card 2
Balance
Monthly Payment
Other Owed To 1
Original Amount
Unpaid Balance
Monthly Payment
Other Owed To 2
Original Amount
Unpaid Balance
Monthly Payment
Your Employer
Your Income
per
Net or Gross
Net Gross
Other Income Source
Amount
per


Co-Applicant
Your Name
Your Birth Date
Your Account Number #
Marital Status
Married    Unmarried    Separated
Social Security #
Drivers License #
DL State
Address
City, State Zip Code
,
Years at Address
Own or Rent
Own    Rent/Other
Work Phone
Home Phone
Mobile Phone
Email
Mortgage Owed To
Monthly Mortgage
Person Responsible for Mortgage
Mortgage Balance
Mortgage APR
Credit Card 1
Balance
Monthly Payment
Credit Card 2
Balance
Monthly Payment
Other Owed To 1
Original Amount
Unpaid Balance
Monthly Payment
Other Owed To 2
Original Amount
Unpaid Balance
Monthly Payment
Your Employer
Your Income
per
Net or Gross
Net Gross
Other Income Source
Amount
per


Final Confirmation

By clicking Yes below you authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. You understand the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you.

Applicant
Applicant's Confirmation
Yes
Co-Applicant
Co-Applicant Confirmation
Yes