Loan Application

Getting Started

Amount Requested	Purpose of Loan
$

Personal Information

Primary Applicant First Name Last Name M.I. SSN Birthdate (mm/dd/yyyy) Home Phone Cell Phone () -Second partThird part () -Second partThird part Email Address Physical Address City State ZIP Code Years at this address Rent/Mortgage Payment $ Own OutrightOwnRentWith RelativesOther Mailing Address City State ZIP Code Driver's License # State

Joint Applicant Type of Applicant Co-ApplicantSpouseGuarantor First Name Last Name M.I. SSN Birthdate (mm/dd/yyyy) Home Phone Cell Phone () -Second partThird part () -Second partThird part Email Address Physical Address City State ZIP Code Years at this address Rent/Mortgage Payment $ Own OutrightOwnRentWith RelativesOther Mailing Address City State ZIP Code Driver's License # State

Previous Address

Primary Applicant Address 1 Years? Address 2 Years? Address 3 Years?

Joint Applicant Address 1 Years? Address 2 Years? Address 3 Years?

Employment/Income

Primary Applicant Employer Work Phone () -Second partThird part Employer's Address City State ZIP Code Position/Job Title Gross Monthly Income Start Date (mm/dd/yyyy) $ Other Income per Month Source $ If employed in current position less than three years, complete the following Previous Employer Previous Employer's Address Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy)

Joint Applicant Employer Work Phone () -Second partThird part Employer's Address City State ZIP Code Position/Job Title Gross Monthly Income Start Date (mm/dd/yyyy) $ Other Income per Month Source $ If employed in current position less than three years, complete the following Previous Employer Previous Employer's Address Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy)

References

Primary Applicant Name and Address of Depository Checking Account # Name of relative not living with you Relationship Home Phone () -Second partThird part Relative's Address Name of a personal friend - not a relative Relationship Home Phone () -Second partThird part Friend's Address

Joint Applicant Name and Address of Depository Checking Account # Name of a relative not living with you Relationship Home Phone () -Second partThird part Relative's Address Name of a personal friend - not a relative Relationship Home Phone () -Second partThird part Friend's Address

Type of Credit Requested

IMPORTANT: Check the appropriate boxes and complete the applicable sections:
Type of Credit Requested
SecuredUnsecured
If Secured:
Year	Make	Model	VIN	Mileage
Options
Individual Credit: Relying solely on my income or assets Individual Credit: Relying on my income or assets as well as income or assets from other sources Joint Credit: We intend to apply for joint credit

Finishing Up

Contact Method
Comments
Loan Promo Code
User Agreement
Everything that I have stated in this application is correct to the best of my knowledge. The Credit Union is authorized to check my credit, employment history, obtain a credit report and to answer questions about their credit experience with me. I understand that it may be a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of the United States Criminal Code.
I have read and accept the terms
Account Disclosures
I have read, understand and agree to the terms of application.
E-Sign Act Disclosure
I have read, understand and agree to the E-Sign Act.

Primary Signature	Joint Signature	Date (mm/dd/yyyy)
Please enter the security code below prior to submitting the form