Becker Office: (763) 262-9888
Albertville Office: (763) 777-9360
NMLS# 1070892
Secure Loan Application
Click here for VISA Credit Card Disclosure

Account Number - If You Are A Member Amount Requested Type Of Loan Applying For Term
$ Months

Individual or Joint Request:
This is an individual credit request based on the credit worthiness of the applicant listed below.
This is a joint credit request based on the credit worthiness of both applicants listed below.

 
PRIMARY APPLICANT
 
JOINT APPLICANT

Name: First, Middle, Last

Name: First, Middle, Last
Social Security Number:
Date of Birth:
 
Social Security Number:
Date of Birth:
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:
Current Employer:
Business Phone:
Length Of Employment:
Position:
Gross Salary:
$
Frequency:
 
Current Employer:
Business Phone:
Length Of Employment:
Position:
Gross Salary:
$
 
Frequency:
If Less Than 2 Years Previous Employer:
  If Less Than 2 Years Previous Employer:
Position:
  Position:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
 
OTHER INFORMATION
(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.)
 
Please tell us about your debts:
Lender
Type
Balance
Min. Pmt.
Mortgage/Monthly Rent
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
 
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 Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or You Are A Party To A Lawsuit?
 
Reference
Nearest Relative NOT Living with you:
Name:
First: Middle: Last: Suffix:
What is their home address?
City: State:
Home Phone Number:
What is the relationship?

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 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 forceand effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature.

You understand that the use of your card will constitute acknowledgement or receipt and agreement to the terms of the credit card agreement and disclosures. You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. When you are in default, you authorize us to apply the balance in these accounts to any amounts due.

By pressing the "Submit Application" 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.