Secure Loan Application Form

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

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


Type Of Loan Applying For

By this application the undersigned member(s) applies for a loan account(s) with the above named credit union in

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)
Joint Credit (Provide information about both of you by completing both sections on this application)

Repayment: Payroll Deduction Cash Automatic Payment


Payment Protection Coverage
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Single Credit Life Insurance                      Single Credit Life and Single Disability    
Joint Credit Life                                         Joint Credit Life and Single Disability      

Account Information
Share Draft or Checking Account No.                            Where           
Share or Savings Account No.                                       Where           

Applicant Information
Applicant's Name:
Birthdate:
Present Street Address:
City: State:
Zip #:
Years There:
Monthly Housing Payment:
Home Phone #:
Mobile Phone #:
Are you in the military?
Are you a dependent of
an active military soldier?
Social Security #:
US Citizen: Yes No
Driver's License #:
State:
Email Addess:
Previous address:
Applicant's Name:
Birthdate:
Present Street Address:
City: State:
Zip #:
Years There:
Monthly Housing Payment:
Home Phone #:
Mobile Phone #:
Are you in the military?
Are you a dependent of
an active military soldier?
Social Security #:
US Citizen: Yes No
Driver's License #:
State:
Email Addess:
Previous address:

Employment Information
Applicant Employer's Name:
Employer Address:
Years There:
Title:
Employer Phone #:
Department:
Supervisor:
Monthly Gross Income ($):
Other Income ($): per Month
NOTE: 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 listed to be reduced within the next two years?
$
If yes, please explain:
Previous Employers Name:
Yrs Employed:
Prev. Employer Address:
Applicant Employer's Name:
Employer Address:
Years There:
Title:
Employer Phone #:
Department:
Supervisor:
Monthly Gross Income ($):
Other Income ($): per Month
NOTE: 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 listed to be reduced within the next two years?
$
If yes, please explain:
Previous Employers Name:
Yrs Employed:
Prev. Employer Address:

Debts
Child Support Payments / Alimony $
Alimony, chld support or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this loan.
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:             Joint:     

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?

References
(Nearest relative not living with you)
First Name: Middle Name: Last Name: Suffix:
   Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?
First Name: Middle Name: Last Name: Suffix:
   Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?

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.

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.