Consol CU Home Page

Secure Loan Application Form

1000 Consol Energy Dr. Canonsburg, PA 15317
Phone: (724)-485-4850 | Fax: (724-)485-4805

   
Type Of Loan Applying For

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

  1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI)
  2. your spouse will use the account, or
  3. you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: Each Applicant must individually complete the appropriate section below, If Co-Borrower is spouse of the Applicant,- mark the Co-Applicant box.

Guarantor: Complete the Other section if you are a guarantor on an account/loan.

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

Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account.

Are you applying for individual or joint credit ?: Individual    Joint

Type of Loan Applied For:
New Vehicle Used Vehicle Education (Consol Reimbursed) Motorcycle/ATV
Personal Signature Share Secured Other

Purpose of Loan:

Amount Requested: $ .00       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

Repayment:    Payroll Deduction   Coupons   ACH



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 Disability (Primary Member Only)       None
Single Credit Life Insurance       Joint Credit Life Insurance       None


Applicant Information
Applicant's Name:
Account #:
Driver License #:
Social Security #:
Email:
US Citizen: Yes No
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #:
Driver License #:
Social Security #:
Email:
US Citizen: Yes No
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:


Employment Information
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.
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs 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.


Debts & Assets
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00

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:



 
References
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


Contact Method
  How would you prefer to be contacted? Home Phone Cell Phone Email
 
  Additional Comments:


Submit Application

State Law Notices
OHIO RESIDENTS ONLY: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 768.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

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 "Submit Form" 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.