P. O. Box 676, Katy, TX 77492
Phone: (281) 391-2149 
To locate our fax numbers, please Click Here
Secure Loan Request

Member Number Amount Requested Type Of Loan Requested Term Select A Branch Office
$ Months
         
Loan Purpose:

By this application the undersigned member(s) applies for a loan account(s) with the above named credit union in accordance with the terms and conditions set forth in the credit union's credit agreement.
Individual Credit: (Do not complete MARITAL STATUS Section for INDIVIDUAL credit in non-community states.)
     Applicants Signature Only
     Endorser, guarantor or surety (Co-Maker) Name  

Joint Credit: (Provide information about both of you by completing both sections on this application.)
        Applicant ________     Co-Applicant________


PRIMARY APPLICANT
 
JOINT APPLICANT

Name: First, Middle, Last

Name: First, Middle, Last
Social Security Number:
Date of Birth:
Driver's License Number:
State:
 
Social Security Number:
Date of Birth:
Driver's License Number:
State:
What Is Your Email Address?
  What Is Your Email Address?
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:

 
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:

What Is Your Home Address?
Street: City:
  What Is Your Home Address?
Street: City:
State: Zip:
 
State: Zip:
Monthly Housing Payment: $   Monthly Housing Payment:  $

 
Current Employer:
Business Phone:
 
Current Employer:
Business Phone:
Length Of Employment:   Length Of Employment:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
 
REFERENCES
Nearest Relative (Not Spouse):   Personal:
 
Phone:   Phone:
Address:   Address:
     
 
MARITAL STATUS
MARITAL STATUS: Complete marital status if this loan is for:
   a. Joint or secured credit, or
   b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
Applicant:     
Other Party:     
     
LIST ALL DEBTS
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
     
OTHER INFORMATION
 
Have You Filed For Bankruptcy? Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgments?

You agree that everything stated in this request 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 to answer questions about their credit experience with you. If a credit report is necessary, individual reports will be charged $3.50 and joint reports will be charged $7.00. You understand that any false or misleading statement in your request may cause any loan or extension of credit to be in default. You authorize us to accept your electronic signatures on this request and agree that your electronic 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 electronic signature. Security on one loan is security on any monies owed to the Credit Union.

I/WE SPECIFICALLY GRANT YOU A CONSENSUAL SECURITY INTEREST IN ALL INDIVIDUAL AND JOINT ACCOUNTS I/WE HAVE WITH YOU NOW AND IN THE FUTURE TO SECURE REPAYMENT OF THE CREDIT EXTENSIONS MADE UNDER THE CREDITUNION'S CREDIT AGREEMENT. THE GRANTING OF THIS SECURITY INTEREST IS A CONDITION FOR THE CREDITUNION'S CREDIT AGREEMENT. Shares and deposits in an Individual Retirement Account or any other account that would lose special tax treatment under state or federal if given as security are not subject to the security interest being given.

The undersigned member(s) requests for a loan account(s) with the above named credit union in accordance with the terms and conditions set forth in the Credit Union's Credit Agreement.

PLEASE MAIL, FAX, OR BRING TO OUR OFFICE YOUR MOST RECENT PAY CHECK STUB.

TO SUBMIT ELECTRONICALLY, PROVIDE YOUR ELECTRONIC SIGNATURE BELOW,
THEN PRESS THE “SUBMIT” BUTTON

Brazos Valley Schools Credit Union will accept this electronic signature executed by you as the
legally binding equivalent of a traditional, hand written signature for this form. The electronic signature consists of your first name, last name and the last 4 digits of your social security number.

Primary Applicant’s Signature:
First Name, Last Name, Last 4 digits of your Social Security Number
(example: Mary Member 1234)


Co-applicant’s Signature, if applicable:
First Name, Last Name, Last 4 digits of your Social Security Number
(example: Mary Member 1234)

By pressing the "Submit Request" button below, you agree to the above statement. You understand that we may require additional information to finalize our credit decision and your signature on additional documents prior to disbursing any credit proceeds.