5310 DTC Parkway, Suite H
Greenwood Village, Co. 80111
Fax: (720) 493-1604
Telephone: (720) 493-1270
Privacy Notice: For maximum security this form uses SSL encryption and server authentication. If you do not wish to submit the application on line, please complete the form below, print it, sign it and fax it to the credit union's private fax number (720) 493-1604. You may also mail or deliver a signed copy to the credit union.
TYPE OF LOAN
Auto (New - Used - Refinance)
Motorcycle
Personal Loan
Home Equity Loan
APPLICANT (Print or type all information)
Name (First - MI - Last)
Address (Street - County / City - State - Zip)
Soc. Sec. Num.
Home Phone
Age of Dependants
Name - of nearest relative not living with you / How Related
Address of nearest relative not living with you
Driver's License / Make, Model & Year of Vehicles Owned
SPOUSE / CO-APPLICANT
Name (First - MI - Last)
Address (Street - County / City - State - Zip)
Soc. Sec. Num.
Home Phone
Age of Dependants
Name - of nearest relative not living with you / How Related
Address of nearest relative not living with you
Driver's License / Make, Model & Year of Vehicles Owned
OCCUPATION AND INCOME (If self-employed or retired, attach financial statement and/or tax return)
Current Employer / Work Phone
Address (Street / City / State - Zip)
Position / Employment Date / Gross Monthly Pay
Current Employer / Work Phone
Address (Street / City / State - Zip)
Position / Employment Date / Gross Monthly Pay
OTHER INCOME
Type of other Income / Monthly Amount
Name - Address of Payer / Day Time Phone
Type of other Income / Monthly Amount
Name - Address of Payer / Day Time Phone
STATEMENT OF OBLIGATIONS
REGULAR PAYMENTS SUCH AS FOR HOME OR APARTMENTS, FURNITURE, DOCTORS, CHILD SUPPORT, ALIMONY, AND/OR MAINTENANCE PAYMENT
CREDITORS
Name and Address
Account Number
Balance
Total Monthly Payment
Mortgage
Rent
Variable
Fixed
Auto Loan
Variable
Fixed
Credit Card
Credit Card
Other
Other
Alimony / Child Support
Totals
Debt to Gross Income
Have you filed for Bankruptcy or Chapter 13 in the past 10 years?
Yes
No
Year Filed
Explain
Have your wages ever been garnished?
Yes
No - By Whom
Year
Have you ever had collateral repossessed?
Yes
No - By Whom
Year
Are you a co-maker on any other loans?
Yes
No - If so, how much?
For Whom
CREDIT APPLICATION
I hereby apply for a loan of $ for a period of
Weeks
Months
to be paid in
installments
of $ Each
Including Interest
Plus Interest
Co-maker or security offered
By submitting this application you certify the following:
You promise that everything you have stated in this application is
correct to the best of your knowledge. lf there are any important changes
you will notify us in writing immediately. You authorize the Credit Union
to obtain credit reports in connection with this application for credit and
for any update, increase, renewal, extension, or collection of the credit
received. You understand that the Credit Union will rely on the information
in this application and your credit report to make its decision. lf you
request, the Credit Union will tell you the name and address of any credit
bureau from which it received a credit report on you. lt is a federal crime
to willfully and deliberately provide incomplete or incorrect information on
loan applications made to federal credit unions or state chartered credit unions insured by NCUA.
You understand that the use of your credit card will constitute
acknowledgment of 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. Shares and deposits in an Individual Retirement
Account, and any other account that would lose special tax treatment
under state or federal law if given as security, are not subject to the
security interest you have given in your shares and deposits.
X________________________________
Applicant Signature and Date
X________________________________
Co-Applicant Signature and Date