Loan Application


Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

1.you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI),

2.your spouse will use the account, OR

3.you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: If you are applying with another person, complete the Applicant and Other sections. 
Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Select One *
Repayment *
Payment Protection
Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
Applicant
Name *
Name
Birth Date *
Birth Date
Phone *
Phone
Present Address *
Present Address
*
Previous Address *
Previous Address
*
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
NAME AND ADDRESS OF EMPLOYER
Start Date *
Start Date
Supervisor's Name
Supervisor's Name
$______ (Net/Gross) Per ________
$________ Per_______ Source_______
Where? Ending/Separation Date
Start/End Date
Other
Name
Name
Birth Date
Birth Date
Phone
Phone
Present Address
Present Address
Previous Address
Previous Address
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
NAME AND ADDRESS OF EMPLOYER
Start Date
Start Date
$______ (Net/Gross) Per ________
$________ Per_______ Source_______
Where? Ending/Separation Date
Start/End Date
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP PHONE
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP PHONE
You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify use in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and any update, increase, renewal or extension of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.
Date *
Date
Date
Date