Loan Application
Current Employment Length Calculation
Previous Employment Length Calculation
Application Date
-
Month
-
Day
Year
Date
Personal Information
Member Number
Full Name
*
First Name
Last Name
Social Security Number
*
Citizenship Status
U.S. Citizen
Non-Resident
Resident Alien
Active Military
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Married
Yes
No
Email
example@example.com
When did you move into your house?
-
Month
-
Day
Year
Date
Type of Residence
Own
Rent
Living with Family
Monthly Rent Amount
Physical Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is your physical address identical to your mailing address?
Yes
Mailing Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Loan Information
Loan Type
*
Auto
Home Loan
Share Secured
Unsecured
Boat
Recreational/RV/ATV
Farm Equipment
Business Loan
Credit Card
Other
Requested Amount
*
Purpose of the Loan
Length of the Loan
1 year
2 years
3 years
4 years
5 years
6 years
Other
Monthly Payment Range
Year
Make
Model
Mileage
VIN
If approved, how would you like to close your loan?
In Person
Email
Preferred loan due date (day of the month)
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Employment
Current Employment
Company
*
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
Job Title
What is your current supervisor's name?
Start Date
*
-
Month
-
Day
Year
Date
Pay Type
Hourly
Salary
W-2
1099
Pay Rate
*
Hours Per Week
Pay Frequency
Weekly
Bi-weekly
Monthly
Previous Employment #1
If current is less than 2 years
Company
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
Job Title
Supervisor
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Pay Type
Hourly
Salary
W-2
1099
Pay Rate
Hours Per Week
Pay Frequency
Weekly
Bi-weekly
Monthly
Previous Employment #2
If last previous employer is less than 2 years
Company
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
Job Title
Supervisor
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Pay Type
Hourly
Salary
W-2
1099
Pay Rate
Hours Per Week
Pay Frequency
Weekly
Bi-weekly
Monthly
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Additional Income
Source
*
None
Child Support
Alimony
Separate Maintenance Income
Amount
Will You Continue to Receive this Additional Income for the next 3 years?
Yes
No
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References
List of References (List at least one reference that is the nearest relative not currently living with you)
Name
City
State
Phone Number
Relationship
1
2
3
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Credit Questions
Are you a co-maker/endorser on any note?
Yes
No
Is military duty station transfer expected within the next year?
Yes
No
Are you a member of another credit union?
Yes
No
Are there currently any outstanding judgements against you?
Yes
No
Unknown
Have you filed bankruptcy in the last 7 years?
Yes
No
Bankruptcy Date
-
Month
-
Day
Year
Date
What chapter was the bankruptcy filed under?
Do you have any foreclosures or lost titles/deeds on any property within the past 7 years?
Yes
No
Are you a party to any active lawsuit?
Yes
No
Is your citizenship status anything other than a US citizen or permanent resident alien?
Yes
No
Is your income likely to decline within the next 2 years?
Yes
No
Do you have a co-signer if needed?
Yes
No
Are you open to a counter offer on your loan?
Yes
No
Do you have collateral if required?
Yes
No
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Document Checklist
If the member has any of the below documents with them, obtain copies to scan in with their questionnaire. Let the member know of any remaining documents required for when a loan officer contacts them.
Upload Any Required Documents Here
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Additional Notes
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Submitted by
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Last Name
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