Secure Loan Application

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PLEASE COMPLETE FORM IN FULL, DO NOT LEAVE ANY AREAS BLANK!


Applicant:

Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Driver's License #:
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:

Joint Applicant:

Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Driver's License #:
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:

   
Married Separated Unmarried (Single, Divorced, Widowed)   Number of Dependents:
 
Type of Loan Applied For:
New Vehicle Used Vehicle Education (Consol Reimbursed) Motorcycle/ATV
Personal Signature Share Secured Other
Purpose of Loan:
 
Amount applied for: $         Refinance? (the loan amount must be for add'l $1000)
Desired Length of Repayment (months):
1 Year 2 Years 3 Years 4 Years 5 Years 6 Years
 
Where to send loan papers & check:
Send loan papers & check to my CECU Mine Rep. (Name of CECU Rep.)
I will come to the Credit Union office to sign and pick up my contract & check.
Send loan papers to my home, I understand this could delay the receipt of the check approximately 2 weeks.
 
Method of Payment:
Payroll Deduction
ACH
Coupons
 
Payment Protection Plan:
Mark the coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.

Would you like to purchase Credit Life Insurance
Single Credit Life
Joint Credit Life
None
 
Would you like to purchase Credit Disability Insurance
Yes (Primary Member Only)
None

Employment and Income: Proof of income may be required. If self-employed a financial statement or income tax returns will be needed. Please fax your two most recent pay stubs to 724-485-4805.
Employer Name:

Employer Phone #:
City of Employer:

Position:
Length of Employment:
Monthly Gross Income: $
Other Income: $ per Month
Complete if current employment is less than 2 years:
Previous Employers Name:

Years Employed:
Employer Name:

Employer Phone #:
City of Employer:

Position:
Length of Employment:
Monthly Gross Income: $
Other Income: $ per Month
Complete if current employment is less than 2 years:
Previous Employers Name:

Years Employed:
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.

Credit Information
Please list all open Accounts with a balance.
Applicant
Creditor
Balance
Monthly
Payment
If Paying Off With Loan Check Here
Housing
Rent Own None
Joint Applicant
Creditor
Balance
Monthly
Payment
If Paying Off With Loan Check Here
Housing
Rent Own None

These questions must be answered. If any answers are a yes, please explain:

1. Are there any outstanding legal judgments against you? Yes No
2. Have you ever any had personal property repossessed Yes  No
3. Have you ever filed for bankruptcy. Yes No     If yes:   Chapter 7 Chapter 13
   3a. Year filed?

4. Are you a party in a lawsuit? Yes No
5. Do you have other obligations such as child support, alimony, or similar Liabilities? Yes No
Explanation:


6. Are you a cosigner or a guarantor on any loan not listed above? Yes No
Explanation:

Nearest Relative Not Living With You:
Name: Phone:

Address:


 

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 Request" 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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