ASECU Loan Application v1.1

Name(s) of Applicant*

First Name(s)Last Name

Member Number (If known)

Address of Applicant*

Street Address

Street Address Line 2

CityState

Zip Code

E-mail of Applicant*

Mobile Phone Number*

Date of Birth*

	Applicant	Co-borrower
Birth Dates

Employment Information

	Employment Info
Applicant's Employer
Applicant Position
Co-borrower's Employer
Co-Borrower Position

Purpose of the Loan*

Loan Info

	Amount Requested	Refinancing Old Loan	Total Loan
Loan Info

Payment Information

	Term	Payment	Rate %	Begin Payment_Date
Payment Info

Type of Loan

Collateral (use vehicle to secure loan)Signature only (no collateral required)Share Account

District 206 Payroll Deduction

Yes

Type of Vehicle to be used for collateral:

	Year	Make	Model	Value
Vehicle Info

Names other than yours on the title:

Insurance Company/Agent & Phone

Ability to Repay Loan

Alimony, child support or separate maintenance income does not need to be revealed if you do not wish to have it considered as a basis for repaying this loan.

Outstanding Debts (List Everything)*

	Present Bal	Monthly Payment
Rent or Mortgage
Second Mortgage
Auto Loans
Credit Union
Credit Cards w/Balances
Student Loans
Other1
Other2
Totals

Gross Income*

	Monthly	Annual
Applicant$
Co-borrower$

I HEREBY VERIFY THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE TRUE AND VALID TO THE BEST OF MY KNOWLEDGE AND THE STATEMENT OF INDEBTEDNESS INCLUDES ALL MY OBLIGATIONS WITHOUT EXCEPTION. I AUTHORIZE THE CREDIT COMMITTEE TO VERIFY ALL STATEMENTS MADE HEREIN, INCLUDING VERIFYING MY CREDIT REPAYMENT HISTORY. IN CASE THE LOAN IS NOT GRANTED, THIS APPLICATION WILL REMAIN THE PROPERTY OF THE CREDIT UNION.

Enter Applicant(s) Names to validate this information:*