LOAN APPLICATION

UGEFCU@UGEFCU.COM WWW.UGEFCU.COM FAX 315-733-0228

Amount you would like to borrow:

How many months would you like to pay this loan back?

Purpose of Loan

Would you like GAP Protection? Place an “X”: Yes

or No

The cost for GAP insurance is a one-time fee of $250.00. (Gap insurance is an optional, add-on car insurance coverage that can help certain drivers cover the “gap” between the amount they owe on their car and the car's actual cash value in the event of an accident

Are you interested in having your loan protected (place an “X”)?

Yes

or No

LIFE

and/or DISABILITY

If you answer “yes”, then the credit union will disclose the cost of this voluntary payment protection to you. A separate election which discloses the terms and conditions must be signed for protection to be effective.

Name

Co-Applicant Spouse/Other

Account Number

Account Number Co-Applicant

Date of Birth

Date

Date of Birth Co-Applicant

Date

Home Phone/Cell

Home Phone/Cell Co-Applicant

Present Address

Present Address Co-Applicant

Own or Rent

Amount of Mortgage/Rent

Previous Address

Previous Address Co-Applicant

Name & Address of Employer

Name & Address of Employer Co-Applicant

Employment Gross Income

Employment Gross Income Co-Applicant

Applicant's Signature

Co-Applicant's Signature