Loan Type Loan Amount Requested _______________
How long do you want to finance the loan?
How do you want to repay the loan?
Do you want to insure this loan with optional credit insurance?
   
Yes Single Credit Disability at 30 cents per $100.00 of loan balance per month.
   
Yes Single Credit Life at 7 cents per $100.00 of loan balance per month.
   
Yes Joint Credit Life at 10.5 cents per $100.00 of loan balance per month.
   
No
 Applicant Information
Last ______________________ First ______________________ MI ___
Street _________________________________________  Birthdate  _________________
City _________________________________________   Home _________________ 
State ___        Zip _____________   Work _________________ 
Social Security Number _______________ Account Number _______________
Time at Residence_________________     
   
Buying/Own
   
Rent
   
Other   Monthly Payment____________
 Employment Information (Applicant)
Employer _________________       
Position _________________      Length of Employment_________________     
Employer Address
Street_______________________________________  		 
City________________________________________   
State___        Zip _____________  
Employer Phone_________________
 Gross Salary _________________     
Other Gross Monthly Income _________________     
 Source of Other Income_________________     
Pay Frequency        
   
Weekly
   
Semi-monthly
   
Bi-weekly
   
Monthly
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.
Alimony, child support, separate maintenance received under:
   
court order
   
written agreement
   
oral understanding
 Co-Applicant Information
Last ______________________ First ______________________ MI ___
Street _________________________________________  Birthdate  _________________
City _________________________________________   Home _________________ 
State ___        Zip _____________   Work _________________ 
Social Security Number _______________  
Time at Residence_________________     
   
Buying/Own
   
Rent
   
Other      Monthly Payment _________________ 
 Employment Information (Co-Applicant)
Employer _________________       
Position _________________      Length of Employment_________________     
Employer Address
Street_______________________________________  		 
City________________________________________   
State___        Zip _____________  
Employer Phone_________________
 Gross Salary _________________     
Other Gross Monthly Income _________________     
 Source of Other Income_________________     
Pay Frequency        
   
Weekly
   
Semi-monthly
   
Bi-weekly
   
Monthly

You promise that everything you have stated in this application is correct to the best of you knowledge. If there are any important changes, you will notify us in writing immediately. You authorize the credit union to obtain credit reports in connection with this application for credit and any update, renewal or extension of the credit received. You understand that 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. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.
_______________________________ __________________
Signature Date
You Must Print, Sign, and Return to Credit Union
(in person or by mail)
A signature is needed to complete the process