Loan Application

Loan Application
Please provide all of the requested information. When you have completed the form, press the SUBMIT button to send your application. If necessary, we will contact you for additional information.

The items marked with a (*) are required fields.
Will you be applying for Individual or Joint Credit? (If Joint, the co-applicant section has the same required fields as the primary applicant)

JointIndividual
Complete marital status if this loan is for:

a. Joint or secured credit, or

b. You reside in or rely on property located in a Community Property State (AZ, CA, ID, LA, NV, TX, WA, WI)
Marital Status

UnmarriedMarriedSeparatedThis application is not for joint or secured credit and I do not live in the states listed above.
Type of Loan Requested
Type of Loan Requested*

AutoRecreationPersonal Loan - up to $10,000 max/60 monthsAuto/Recreational Loan RefinanceWinter Rescue Loan - up to $3,500.00/11 months
Loan Amount Requested ($)*
Loan Term Requested*
Primary Applicant
Member Number (if available)
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security Number *
Primary Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Other Number

Area CodePhone Number
Email*
example@example.com
Home Address
Physical Address: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My mailing address is different than my physical address.
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time at current residence (years and months)
Residence Type

OwnRentOther
If rent, please indicate monthly amount
Current Employer
Name
Phone Number

Area CodePhone Number
Employment Status

Full TimePart TimeTempRetiredOther
Job Title
Start Date

MonthDayYear
Date
Gross Salary ($)
Gross Salary per
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income ($)
Other Income per
Other Income Source
Past Employer
Name
Phone Number

Area CodePhone Number
Employment Status

Full TimePart TimeTempRetiredOther
Job Title
Start Date

MonthDayYear
Date
Gross Salary ($)
Gross Salary per
Co-Applicant
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Social Security Number
Home Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Cell Number

Area CodePhone Number
Email
example@example.com
Home Address
Physical Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My mailing address is different than my physical address.
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time at current residence (years and months)
Residence Type

OwnRentOther
If rent, please indicate monthly amount
Current Employer
Name
Phone Number

Area CodePhone Number
Employment Status

Full TimePart TimeTempRetiredOther
Job Title
Start Date

MonthDayYear
Date
Gross Salary ($)
Gross Salary per
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income ($)
Other Income per
Other Income Source
Past Employer
Name
Phone Number

Area CodePhone Number
Employment Status

Full TimePart TimeTempRetiredOther
Job Title
Start Date

MonthDayYear
Date
Gross Salary ($)
Gross Salary per
References
Nearest Relative Not Living With You
Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Debts/Monthly Payments
List all other debts (for example, auto loans, credit cards, second mortgage, home association dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilties, etc.) Please use a separate line for each credit card or auto loan payment.
Additional Information
How would you prefer to be contacted?

Home PhoneWork PhoneCell PhoneEmail AddressOther
Please add me to your email list.
Special Instructions/Comments
Income verification may be required; other information may be required.

I warrant the truth of the above information and I realize that it will be relied upon by the credit union in deciding whether or not to grant the credit applied for. You hereby authorize the credit union, our employees and agents to investigate and verify any information provided to us by this application is for any Feature Categoy contained in Our Credit Line Account Program, you agree and understand that if approved, you are contractually liable according to the application terms of the Credit Line Account Agreement and Disclosure. You will receive a copy of that agreement no later than the time of your first credit advance and you promise to pay all amounts charged to your account according to its terms, if this is a joint application, you agree that the liability is joint and several. You authorize us to accept your signature on this application and that your signature will have the same legal force and effect as your original signature.

You fully understand that it is a federal crime punishable by fine, or imprisonment, or both, if knowingly make any false statements concerning any of the above facts as applicable under provisions of Title 18, United States Code, Section 1014.
I agree to terms and conditions.
Date

MonthDayYear
Date
Applicant Signature *

Clear
Date

MonthDayYear
Date
Co-Applicant Signature

Clear
Should be Empty: