Loan Application
HOW TO
APPLY
  • please complete sections 1 through 8
  • sign section 9
  • return to credit union
    		•
    1
    NOTE AND
    COMPLETE    		 Married Applicants may apply for separate account. Check the appropriate box to indicate individual credit or Joint Credit.
    Individual Credit: Complete Applicant section. Complete co-Applicant, Spouse, guarantor (referred to as "Other") section: (1) about your spouse if you live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI), or (2) if your spouse will use the account, or (3) if there is a guarantor on this account. Please check box to indicate whom the information is about.
    Joint Credit: Provide information about both of you by completing Applicant and Other section
    Amount Requested $ Purpose: Collateral:
    Repayment: Payroll Deduction  Cash Automatic Payment  Military Allotment 
    STATEMENT
    OF INTENT
    Check if desired
    Credit disability Insurance Check coverage(s) desired. the credit union will disclose the cost of this voluntary insurance to you. a separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
    Single Credit Life Insurance
    Joint Credit Life Insurance
    2
    APPLICANT
    INFORMATION
    NAME (last - first - Initial)
    DRIVER'S LICENSE NUMBER / STATE
    /
    ACCOUNT NUMBER SOCIAL SECURITY NUMBER
    BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.
     
    PRESENT ADDRESS (Street - City - State - Zip) OWN   RENT  
    YEARS
    AT THIS
    ADDRESS 
    PREVIOUS ADDRESS (Street - City - State - Zip) OWN   RENT  
    YEARS
    AT THIS
    ADDRESS 
    COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
    MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
    LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT
    (Exclude Self)

    CO APPLICANT SPOUSE GUARANTOR
    Use "SAA" if Information is "Same As Applicant
    NAME (last - first - Initial)
    DRIVER'S LICENSE NUMBER / STATE
    /
    ACCOUNT NUMBER SOCIAL SECURITY NUMBER
    BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.
     
    PRESENT ADDRESS (Street - City - State - Zip) OWN   RENT
    YEARS
    AT THIS
    ADDRESS 
    PREVIOUS ADDRESS (Street - City - State - Zip) OWN   RENT
     
    YEARS
    AT THIS
    ADDRESS 
    COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
    MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
    LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT
    (Exclude Self)

    3
    EMPLOYMENT
    INFORMATION




















                MILITARY



























                MILITARY

    NAME OF EMPLOYER
    ADDRESS OF EMPLOYER
    YOUR TITLE/GRADE SUPERVISOR'S NAME
    START DATE HOURS AT WORK IF SELF EMPLOYED, TYPE OF BUSINESS
    IF EMPLOYED IN CURRENT POSITION LESS THAN FIVE YEARS.
    STARTING DATE
    ENDING DATE
    COMPLETE PREVIOUS EMPLOYER NAME AND ADDRESS
    IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR
      YES   NO
    WHERE      ENDING/SEPARATION DATE

    NAME OF EMPLOYER
    ADDRESS OF EMPLOYER
    YOUR TITLE/GRADE SUPERVISOR'S NAME
    START DATE HOURS AT WORK IF SELF EMPLOYED, TYPE OF BUSINESS
    IF EMPLOYED IN CURRENT POSITION LESS THAN FIVE YEARS.
    STARTING DATE
    ENDING DATE
    COMPLETE PREVIOUS EMPLOYER NAME AND ADDRESS
    IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR
      YES   NO
    WHERE      ENDING/SEPARATION DATE
    4
    APPLICANT
    INFORMATION
    Please Include Street, City, State and Zip
    NAME AND ADDRESS OF CREDITOR(S) OF DEBTS PAID OFF
          		TELEPHONE
    NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
          		RELATIONSHIP

    HOME PHONE
    NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
          		HOME PHONE

    NAME AND ADDRESS OF CREDITOR(S) OF DEBTS PAID OFF
          		TELEPHONE
    NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
          		RELATIONSHIP

    HOME PHONE
    NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
          		HOME PHONE
    5
    INCOME
    INFORMATION
    NOTICE : Alimony child support, or separate maintenance income need not be revealed if you do not choose to have it considered
    EMPLOYMENT INCOME   OTHER INCOME
    $ PER   $ PER
    NET GROSS   SOURCE  

    EMPLOYMENT INCOME   OTHER INCOME
    $ PER   $ PER
    NET GROSS   SOURCE  
    6
    ASSETS

































    Check box for applicant/Other. List all assets and account number(s) - Attach other sheets if necessary
    SHAREDRAFT OR CHECKING AMOUNT NAME AND ADDRESS OF DEPOSITORY
    $
    SAVINGS AMOUNT NAME AND ADDRESS OF DEPOSITORY
    $
    SHAREDRAFT OR CHECKING AMOUNT NAME AND ADDRESS OF DEPOSITORY
    $
    SAVINGS AMOUNT NAME AND ADDRESS OF DEPOSITORY
    $

    APPLICANT
        OTHER
    		  List Home And All Other Items You Own
    And location Of Property
    For Example: auto, Boat, Stocks, Bonds,
    Cash, Household Goods, Real Estate, etc.    		 Market Value Pledged as
    Collateral For
    another Loan
    HOME   $ YES NO
        $ YES NO
        $ YES NO
    7
    DEBTS
    In addition to Rent/Mortgage list all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance. IRS liabilities,etc.) Please use a separate line for each credit card and auto loan. attach other sheets if necessary
    APPLICANT
        OTHER
    		  ORIGINAL
    BALANCE     		PRESENT
    BALANCE     		MONTHLY
    PAYMENT     		PAST DUE
    RENT MORTGAGE
    (Incl. Tax & ins.)    		 $ $ $
    CREDITOR NAME AND ADDRESS
    		 ACCOUNT NUMBER
    $ $ $
    CREDITOR NAME AND ADDRESS
    		 ACCOUNT NUMBER
    $ $ $
    CREDITOR NAME AND ADDRESS
    		 ACCOUNT NUMBER
    $ $ $
    CREDITOR NAME AND ADDRESS
    		 ACCOUNT NUMBER
    $ $ $
    CREDITOR NAME AND ADDRESS
    		 ACCOUNT NUMBER
    $ $ $
    CREDITOR NAME AND ADDRESS
    		 ACCOUNT NUMBER
    $ $ $
    CREDITOR NAME AND ADDRESS
    		 ACCOUNT NUMBER
    List any Names under Which Your Credit References And Credit History Can Be Checked
    TOTALS
    		$ $ $
    8
    FINANCIAL
    INFORMATION
    These questions apply to both Applicant and Other.
      APPLICANT OTHER
    IF A "YES" ANSWER IS GIVEN TO A QUESTION, EXPLAIN ON AN ATTACHED SHEET YES NO YES NO
    DO YOU HAVE ANY OUTSTANDING JUDGMENTS?
    HAVE YOU EVER FILED FOR BANKRUPTCY OR HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13?
    HAVE YOU HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS?
    ARE YOU A PARTY IN A LAWSUIT?
    ARE YOU OTHER THAN A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?
    IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?
    ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE?
    FOR WHOM (Name of Others Obligated on Loan):      TO WHOM (Name Of Creditor):
    9
    SIGNATURES     		If there are any important changes,you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter.
    You also promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of all your debts and obligations. 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. 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. You understand that 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.
    X__________________________________________________ X____________________________________________________
    OTHER SIGNATURE DATE APPLICANT'S SIGNATURE DATE
    10
    CREDIT UNION
    INFORMATION
    Do not write in this section - for credit union use only. Check applicable box(es).
    _______ APPROVED
    LIMITS     		$___________ $_______________ $________ $________ $___________
    DATE SIGNATURE LINE OF CREDIT OTHER OTHER DEBT RATIO
    LOAN OFFICER ADVANCE APPROVED:   YES     NO       COUNTER OFFER WILL BE MADE,
    IF ACCEPTED, ADVANCE APPROVED
    CREDIT COMMITTEE OR OTHER  
    OUTSIDE INFORMATION CONSIDERED:
    YES NO      IF, YES ATTACH ADDITIONAL SHEET AND DESCRIBE
    REFERRED TO/REASON(S) FOR REFERRAL:__________________________________________________________________ 
    DESCRIBE COUNTER OFFER:_______________________________________________________________________________
    SPECIFIC REASON(S) FOR REJECTION:______________________________________________________________________
    SIGNATURES:
    LOAN OFFICER
    X___________________________ DATE____________    X___________________________ DATE____________
    CREDIT COMMITTEE
    X___________________________ DATE____________    X___________________________ DATE____________
    ECOA NOTICE AND REASON FOR REJECTION SENT AND DELIVERED ON:
     _____________________ (DATE)   BY_______________________________      ________(INITIALS)
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    © 2002 Artesian City FCU.
    All rights reserved.
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