Please Enter your Email Address:

Please Enter your Home Phone Number:

If you are applying for joint credit, secured credit or if you live in a community property state
(AZ,CA,ID,LA,NM,NV,TX,WA,WI,Puerto Rico), please complete the following:
Married Separated Unmarried (Single, Divorced, Widowed)

If you are applying for joint unsecured credit, please choose one of the following (otherwise leave blank):
Married Separated Unmarried (Single, Divorced, Widowed)

Type of Loan Applied For:
Personal (Signature) VISA Credit Card Share Secured Unsecured Line of Credit
New Car Used Car Home Equity
Other:

Amount requesting: $
Purpose:
Desired Length of Repayment (months):

Method of Payment:
Coupons Payroll Deduction Automatic Transfer from Shares Drafts

NOTE:
You may qualify for .5% off for doing payroll deduction and .25% off for getting 2 or more services!

Are you interested in having your loan protected?
Yes
None
If you answer “yes”, the credit union will disclose the cost to protect your loan. The protection is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.

Payment Protection Plan:
Would you like to purchase Credit Life Insurance?
(Not Available On VISA Credit Cards):
Single Credit Life (Only Available for Applicant)( Approximately $.61 per $1,000)
Joint Credit Life (Approximately $.92 per $1,000)
None

Would you like to purchase Credit Disability Insurance?
(Not Available On VISA Credit Cards):
Single Credit Disability ( Approximately $1.70 per $1,000)
Joint Credit Disability ( Approximately $2.97 per $1,000)
None

Nearest Relative Not Living With You:
Name: Phone:

References:
Name: Phone:

Address:

Name: Phone:

Address:

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Applicant: Name: Account #: Social Security #: Birthdate (MM/DD/YY): Home Phone #: Present Address: Street: City: State & Zip: Current Address since: (MM/YY) If less than 3 yrs enter previous address:	Joint Applicant: Name: Account #: Social Security #: Birthdate (MM/DD/YY): Home Phone #: Present Address: Street: City: State & Zip: Current Address since: (MM/YY) If less than 3 yrs enter previous address:
Employment and Income: In order to expedite the processing of your loan application please fax your paystub copies to (920) 478-2153, Attention: Loan Department. If self-employed or retired, financial statement or income tax returns will be needed.
Employer Name: Employer Phone #: Employer Address: Position: Date Hired (MM/DD/YY): Monthly Gross Income: $ Other Income: $ per Month	Employer Name: Employer Phone #: Employer Address: Position: Date Hired (MM/DD/YY): Monthly Gross Income: $ Other Income: $ per Month
NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.
Complete if current is less than 2 years: Previous Employers Name: Years Employed:	Complete if current is less than 2 years: Previous Employers Name: Years Employed:

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Credit Information
Please list all open Accounts with a balance.

Creditor Monthly Payment Housing Rent Own None	Creditor Monthly Payment Housing Rent Own None
These questions must be answered. If any answers are a yes, please explain: 1. Do you have other loan applications pending at other financial institutions? Yes No 2. Are there any outstanding legal judgments against you? Yes No 3. Have you ever filed for bankruptcy or had a debt adjustment plan       Confirmed under Chapter 13? Yes No 4. Are you a party in a lawsuit? Yes No 5. Is your status other than U.S. Citizen or Permanent Resident Alien? Yes No 6. Do you have other obligations such as child support, alimony, or similar Liabilities? Yes No 7. Are you a co-maker, cosigner, or a guarantor on any loan not listed above? Yes No Explanation: Are there any other assets, liabilities, obligations or considerations that we should know about in reviewing this application? Yes No If yes please explain:
VISA Credit Card Disclosure Annual Percentage Rate Grace Period Method of Computing the Balance Annual Fee Minimum Finance Charge Transaction Fee For Purchases 12.9% (Periodic rate used to compute the Finance Charge is 1.075% per month.) Purchases-25 days Cash Advances accrue interest from the date they are posted to the account. Average Daily Balance Method (including new purchases). NONE NONE NONE Other Fees: Over the Limit - $15; Late Payment (after 10 days) - $15; Returned Check - $15; Document Copy - $5; Card Replacement - $5   Collection Costs: The extent permitted by Wis. Stat. sec. 422.413, will be required to pay the Credit Union's collection expenses, including statutorily permitted court costs and attorney's fees.
You agree that everything stated in this application is correct to the best of your knowledge. The Credit Union is authorized to investigate your creditworthiness, employment history, and to obtain a credit report and to answer questions about their credit experience with you. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default. You authorize us to accept your facsimile signatures on this application and agree that your facsimile signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature. By pressing the "Send Application" button below, you agree to the above statement. You understand that we may require your signature on additional documents prior to disbursing any credit proceeds.
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