Loan Application

Loan Information

Applicant Information

References

Agreement

Loan Information
- Loan Type *
- - Year*
  - Make*
  - Model or VIN*
  - Mileage*
- Loan Amount *
- Payment Method *
- Application Type *
  Individual Joint
Applicant Information
- First Name *
- Last Name *
- Date of Birth *
- Account Number
- Social Security Number *
- Driver's License Number
- Drivers License State
- Home Phone *
- Cell Phone
- Work Phone *
- Email
- Preferred Contact Method *
- Address *
- Address
- City *
- State *
- Zip *
- Housing Type*
- Years and Months at address *
- Mortgage Holder or Landlord Name
- Monthly rent or board
- Mortgage Balance
- Mortgage Payment
- Previous Address
- Previous Address
- Previous City
- Previous State
- Previous Zip
- Self Employed *
  Yes No
- Job Title *
- Employer Name *
- Employer Address *
- Employer City *
- Employer State *
- Employer Zip
- Years and months at job *
- Gross salary per pay period
- Pay frequency*
- Previous Employer Name
- Previous Employer Address
- Previous Employer City
- Previous Employer State
- Previous Employer Zip
- Previous Years and months at job
- Additional Income
- Other Income Source
- Additional Income Gross Monthly Amount
- Pay frequency
Agreement
- Do you have any outstanding judgments? *
  Yes No
- Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?*
  Yes No
- Have you had property foreclosed upon or repossessed in the last 7 years?*
  Yes No
- Are you other than a U.S. Citizen or permanent resident alien? *
  Yes No
- Is your income likely to decline in the next two years? *
  Yes No
- Are you a co-maker, co-signer or guarantor on any loan not listed above? *
  Yes No
- If yes, what is the monthly payment *
- Are you liable for alimony, child support or maintenance programs? *
  Yes No
- If yes, what is the monthly payment *
I/We agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Funds availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of a copy of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
- Primary Applicant Date *
- Joint Applicant Date *

Loan Information

Applicant Information

If less than 2 years at current address:

Employment Information

If employed for less than 2 years at your current job:

Additional Income

Joint Applicant Information

If less than 2 years at current address:

Employment Information

If employed for less than 2 years at your current job:

Additional Income

References

Reference 1

Reference 2

Agreement