*
indicates a required field
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Personal |
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Recreational
Vehicle/Motorcycle |
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New
Auto |
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Home
Equity |
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Used
Auto |
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Boat/Personal
Watercraft |
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Property
and Loan Information |
| *Amount
Requested: |
| *Collateral: |
| Purpose
of Loan: |
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Purchase |
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Construction |
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Refinance |
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Other |
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Explain: |
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| Credit
Life Insurance? |
| Credit
Disability Insurance? |
| Both
Credit Life & Disability? |
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|
Primary
Borrower Information |
| *Name
(First M. Last): |
| *Date
of Birth (mm/dd/yyyy): |
| *Member
Number: |
| *Social
Security Number: |
| *Number
of Dependents: |
| *Driver's
License Number : |
| *E-mail: |
| *Current
Address: |
| *City,
State, Zip: |
| *Current
Home Phone Number: |
| *Do
you: |
| If
owned: |
|
*Current Employer: |
| *Current
Job Title: |
| *Current
Work Address: |
| *City,
State Zip: |
| *Current
Work Phone#: |
| *How
Long: |
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| Date
Purchased ? |
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| Purchase
Price ? |
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| Current
Value ? |
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|
Co-Borrower
Information |
| *Name
(First M. Last): |
| *Date
of Birth (mm/dd/yyyy): |
| *Member
Number: |
| *Social
Security Number: |
| *Number
of Dependents: |
| *Driver's
License Number: |
| *E-mail: |
| *Current
Address: |
| *City,
State, Zip: |
| *Current
Home Phone Number: |
| *Do
you: |
| If
owned: |
|
*Current Employer: |
| *Current
Job Title: |
| *Current
Work Address: |
| *City,
State Zip: |
| *Current
Work Phone Number: |
| *How
Long: |
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| Date
Purchased ? |
|
| Purchase
Price ? |
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| Current
Value ? |
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Monthly
Gross Income |
| |
Borrower
|
Co-Borrower
|
Total |
| *Base
Employ Income: |
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| *Other: |
|
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|
| *Do
you pay: |
|
| If
so, how much? |
|
Nearest
Relative Not Living With You |
| *Name: |
| *Current
Address: |
| *City,
State, Zip: |
| *Current
Home Phone Number: |
|
|
Other Questions
(Check
box for "Yes" or leave blank for "No") |
| Borrower: |
| Are
there any judgments against you? |
YES |
|
NO |
|
|
| Have
you declared bankrupt within the past 7 years? |
YES |
|
NO |
|
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| Have
you had property foreclosed upon or given title/deed in lieu
thereof in the last 7 years? |
YES |
|
NO |
|
|
| Are
you a party to a law suit? |
YES |
|
NO |
|
|
| Are
you obligated to pay alimony, child support, or separate maintenance? |
YES |
|
NO |
|
|
| Is
any of the down payment borrowed? |
YES |
|
NO |
|
|
| Are
you a co-maker or endorser on a note? |
YES |
|
NO |
|
|
| Are
you a US Citizen? |
YES |
|
NO |
|
|
| Co-Borrower: |
| Are
there any judgments against you? |
YES |
|
NO |
|
|
| Have
you declared bankrupt within the past 7 years? |
YES |
|
NO |
|
|
| Have
you had property foreclosed upon or given title/deed in lieu
thereof in the last 7 years? |
YES |
|
NO |
|
|
| Are
you a party to a law suit? |
YES |
|
NO |
|
|
| Are
you obligated to pay alimony, child support, or separate maintenance? |
YES |
|
NO |
|
|
| Is
any of the down payment borrowed? |
YES |
|
NO |
|
|
| Are
you a co-maker or endorser on a note? |
YES |
|
NO |
|
|
| Are
you a US Citizen? |
YES |
|
NO |
|
|
| |
| This
form is for members with an established open-end plan. If you do not
have an open-end plan with the credit union you may submit this application
and a loan officer will contact you with information to start an open-end
plan. After you have signed the open-end plan your loan request will
be processed. |
|
(X) _____________________________________________________________________
*Signature Date
|
|
You Must Print & Return to Credit Union
(in person, by mail or by fax)
|
