P. O. Box 676, Katy, TX 77492
Phone: (281) 391-2149 
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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.) Married Applicants         may apply for separate credit.
     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:
Email Address:
  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:

Present Street Address:
Street: City:
  Present Street Address:
Street: City:
State: Zip:
 
State: Zip:
Years There:   Years There:
Monthly Housing Payment: $   Monthly Housing Payment:  $

 
Previous Street Address:
Street: City:
  Previous Street Address:
Street: City:
State: Zip:
 
State: Zip:
Years There:   Years There:

 
Current Employer:
Business Phone:
EXT:
 
Current Employer:
Business Phone:
EXT:
Street:   Street:
City:   City:
State: Zip:   State: Zip:
Years There:   Years There:
Title:   Title:
Supervisor:   Supervisor:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:

*Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this loan.

Is any income likely to be reduced within the next two years? $
If yes, please explain:
 
Previous Employer:
Business Phone:
EXT:
 
Previous Employer:
Business Phone:
EXT:
Street:   Street:
City:   City:
State: Zip:   State: Zip:
Years There:   Years There:

Share Draft or Checking Account:   Where?
Share or Savings Account:   Where?
 
REFERENCES
Nearest Relative Not Living With You:   Personal:
 
Relationship:   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
Creditor
Type
Balance
Monthly Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
     
OTHER INFORMATION
 
Are there any unsatisfied judgements against applicant and/or other party?
If Yes, By Whom? To Whom? Amount$:  
Are there any other persons obligated on any of the above loans?
Which ones and who?
Is applicant and/or other party (a co-maker, cosigner or gaurantor) on any loan?
For Whom? To Whom?:
Has the applicant and/or other party been the subject of an order for relief under The Federal Bankruptcy Code or adjudicated a bankrupt under the Bankruptcy Act in the last 10 years?

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. 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.