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.

Applicant's Email Address
(only needed for online submission)


TYPE OF LOAN
Auto (New - Used - Refinance)       
Motorcycle
Personal Loan
VISA Classic - see VISA Classic Disclosure and Agreement
VISA Platinum - see VISA Platinum Disclosure and Agreement
VISA Credit Limit Increase

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
CREDITORSName and AddressAccount
Number
BalanceTotal
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

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