Faith Cooperative Federal Credit Union

Faith Cooperative Federal Credit Union

Application For Closed-End Credit
Amount Requested*
First Payment Due Date*

1st of the month15th of each the month
Payment Frequency*

Every WeekEvery 2 WeeksMonthly
Purpose of Loan*
Collateral (Secured Loan)*
INFORMATION REGARDING APPLICANT
Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Present Address Years There*
Home Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
We will contact you for your Social Security Number.
Driver License*
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address Years There
Present Employer*
Position Title*
Business Phone Number*
Please enter a valid phone number.
Supervisor*
Years at Present Employer*
Previous Employer
Previous Position Tile
Previous Job Phone Number
Please enter a valid phone number.
Previous Supervisor
Years at Previous Employer
Number of Dependents (Excluding Self)*
Ages (Separate by using a comma) *
Nearest Relative not living with you*
Relationship*
Relative Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relative Phone Number*
Please enter a valid phone number.
List 3 Personal References (Name, Full Address, Phone)*
Salary Gross Net Amount
Salary Gross Net Amount Per

Per WeekMonthlyAnnually
Other Income
Other Income Per

Per WeekMonthlyAnnually
Source of Other Income
*Alimony, child support, or separate maintenance income need be revealed if you do not wish to have it considered as a basis for repaying this loan.
Is any income listed likely to be reduced within the next two years?

YesNo
If "Yes", please explain
Checking Account & Routing No.
Checking Account Bank Name
Saving Account & Routing No.
Saving Account Bank Name
MARITAL STATUS: Check applicable box(es) below if this loan is for:
Type of Personal Loan

JointSecure Credit
Where you reside or rely on property located in a Community Property State

AZCAIDLANMNVTXWAWIS
Applicant

UnmarriedMarriedSeparate
Other Party

UnmarriedMarriedSeparate
OUTSTANDING DEBTS (Use separate sheet if necessary: Include information about any Joint Applicant.
Outstanding Debt Applicant: Please List (Creditor, Type of Debt or Account #, Names(s) in which account is carried, Past Due (Yes/No), Present Balance, Monthly Payment, Original Debt
Outstanding Debt Other Party: Please List (Creditor, Type of Debt or Account #, Names(s) in which account is carried, Past Due (Yes/No), Present Balance, Monthly Payment, Original Debt
Are there any unsatisfied judgements against applicant and/or other party?

YesNo
If "Yes" of unsatisfied judgements by whom? and To whom?
Are there any other person obligated on any of the above loans?

YesNo
Which one of the loans and who?
Is applicant an/or other party a comaker, cosigner or guarantor on any loan?

YesNo
Who is a cosigner on which one of the loans and who?
Has the applicant/and or other party been the subject of an order for relief under The Federal Bankruptcy Code or adjudicated a bankrupt under the Bankruptcy Act in the last 10 years?

YesNo
Everything that I/we have stated in this application is correct to the best of my/our knowledge. You are authorized to check my/our credit and employment history and to answer questions about your credit experience with me/us.
Signature of Applicant

Clear
Signature of Other Party (Where applicable)

Clear
Should be Empty: