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)
  You Must Print, Sign, and Return to Credit Union