Vicinity Credit Union Loan Application

Vicinity Credit Union Loan Application
I. LOAN INFORMATION
ARE YOU A MEMBER?*

YesNo
AMOUNT OF LOAN REQUEST*
PURPOSE OF LOAN REQUEST*
II. MEMBER APPLICANT
NAME*

First NameMiddle NameLast Name
PRESENT ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
YEARS THERE*
Please provide your previous housing information:*
BIRTHDATE*

MonthDayYear
Date
EMAIL*
example@example.com
MONTHLY MORTGAGE / RENT PAYMENTS
PRESENT EMPLOYER*
POSITION
YEARS THERE
Please provide your previous employer's information:*
PHONE
Please enter a valid phone number.
HOME PHONE
Please enter a valid phone number.
CELL PHONE
Please enter a valid phone number.
$ GROSS MONTHLY SALARY
$ OTHER INCOME SOURCES
$ TOTAL MONTHLY INCOME
III. CO-APPLICANT
IS THERE A CO-APPLICANT FOR THIS LOAN?

YesNo
NAME

First NameMiddle NameLast Name
CO-APPLICANT PRESENT ADDRESS

Street Address

Street Address Line 2

CityState

Zip Code
CO-APPLICANT YEARS THERE
CO-APPLICANT BIRTHDATE

MonthDayYear
Date
CO-APPLICANT EMAIL
example@example.com
CO-APPLICANT HOUSING

RentOwn
CO-APPLICANT PRESENT EMPLOYER
CO-APPLICANT POSITION
CO-APPLICANT YEARS THERE
CO-APPLICANT WORK PHONE
Please enter a valid phone number.
CO-APPLICANT HOME PHONE
Please enter a valid phone number.
CO-APPLICANT CELL PHONE
Please enter a valid phone number.
CO-APPLICANT $ GROSS MONTHLY SALARY
CO-APPLICANT $ OTHER INCOME SOURCES
CO-APPLICANT $ MONTHLY INCOME
IRS TAX FILING
ACCEPTANCE SIGNATURE(S)
I am not indebted to any other Credit Union, bank or loan agency either as maker or endorser, except as stated herein. No consideration has passed or will pass from me, as the borrower, to an endorser for his endorsement. The statements herein are made for the purpose of inducing the Credit Union to make a loan. "For the purpose of determining my eligibility for credit, you are authorized to procure consumer reporting agencies and to obtain personal and credit information from persons other than consumer reporting agencies." I hereby voluntarily represent and warrant to the Credit Union, their, successors, or assigns that I am of legal age to contract, that all of the statements as to my present financial responsibility and status as set forth herein this application are complete, true, and correct. I have no Claims, Suits, nor Judgments against me: neither have I been involved in Bankruptcy Proceedings, except as stated herein.
PRIMARY APPLICANT'S SIGNATURE*
Date

MonthDayYear
Date
SIGNATURE OF JOINT INSURED (CO-APPLICANT)*
Date

MonthDayYear
Date
Should be Empty: