Secure Loan Application

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Please Enter your Email Address:

Married applicants may apply for a separate account. If you are applying for Individual or Joint Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse.

Married Separated Unmarried (Single, Divorced, Widowed)

Type of Loan Applied For:
Personal (Signature) Share Secured New Car Used Car
Special Loan   Other:

Amount applied for: $
Purpose:
Desired Length of Repayment (mon):

Method of Payment:
Coupons Payroll Deduction Automatic Transfer from Savings Checking

Payment Protection Plan:
Would you like to purchase Credit Life Insurance:
Single Credit Life, (Only Available for Applicant)
Joint Credit Life,
None

Would you like to purchase Credit Disability Insurance:
Single Credit Disability (Only Available for Applicant)
Joint Credit Disability
None

Are you a U.S. Citizen?
Yes No

Have you ever had a judgment, bankruptcy, repossesion, or lawsuit?
Yes  No

Do you own your home or vehicle?
Home Value $ Vehicle(s) Value $

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 (815) 434-5860, 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 employment is less than 2 years:
Previous Employers Name:

Years Employed:

Complete if current employment is less than 2 years:
Previous Employers Name:

Years Employed:
Credit Information
Please list all open Accounts with a balance.
Creditor Monthly
Payment
Housing
Rent Own None
Creditor Monthly
Payment
Housing
Rent Own None

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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