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Secure Loan Application
577 NA Sandifer Hwy, Monticello MS 39654
Phone: (601)587-4037  •  Fax: (601)587-4038


Type Of Loan Applying For

New or Used Vehicle Loan
New or Used Boat Loan
Recreational Vehicle (Camper, ATV, Motorcyle, etc.)


Visa Disclosure
I have read and agree with Terms and Conditions
Purpose of loan :
Requested Amount : $ .00

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.
Payment Protection - Life & Unemployment                              Payment Protection - Life & Disability
Payment Protection - Life, Disability & Unemployment              None

Applicant Information
Applicant's Name:
Account #:
Social Security #:
US Citizen: Yes No
Birthdate (MM/DD/YY):
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:
Email Address :
Number of Dependants :
We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.
Home Phone #:
Mobile Phone #:
Address :
City : State:
Zip #:
Current Address since: (MM/YY)
Rent     Own     Payment:
If less than 3 yrs enter previous address:
Number of months at residence:
Joint Applicant's Name:
Is Joint Applicant your spouse? Yes No
Account #:
Social Security #:
US Citizen: Yes No
Birthdate (MM/DD/YY):
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:
Email Address :
Number of Dependants :
We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.
Home Phone #:
Mobile Phone #:
Address :
City : State:
Zip #:
Current Address since: (MM/YY)
Rent     Own     Payment:
If less than 3 yrs enter previous address:
Number of months at residence:

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



Personal Financial Profile
(You may choose to skip this section. Please answer questions below)
Assets
Estimated Value
Liabilities
Dollar Amount Owed
Cash in Credit Unions / Banks:
$ .00
Loans Owed to FFCU:
$ .00
Stocks & Bonds:
$ .00
Credit Cards:
$ .00
Retirement:
$ .00
 
$ .00
Vehicle Year: Make: Vehicle Loan: $ .00
Vehicle Year: Make: Vehicle Loan: $ .00
Home:
$ .00
Mortgage:
$ .00
Other Real Estate:
$ .00
Other Real Estate Loans:
$ .00
 
$ .00
 
$ .00
$ .00
$ .00
$ .00 $ .00
$ .00 $ .00
       
Total Assets $ .00 Total Loan Balances $ .00
    (Total Assets - Total Loan Balances) =
Net Worth
$ .00
These questions must be answered.
Have you ever filed for bankruptcy or had debt adjustment under Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesion in the last 7 years?
   Is your income likely to decline in the next two years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?
Are you a U.S. citizen or permanent resident alien?

Applicant References (Nearest relative not living with you)
Reference #1
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?

Reference #2
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?

 
Co-applicant References (Nearest relative not living with you)
Reference #1
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?

Reference #2
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?

Submit Application
I/We understand that credit union membership is required to fully process this loan application and further documentation / signatures may be required. By submitting this form with your electronic signature(s), you agree that everything stated in this application is correct to the best of your knowledge and grant permission to credit union to perform the following. The Credit Unionis authorized to validate your information, investigate your creditworthiness, employment history, and obtain a credit report. 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. The Credit Union may keep this application whether or not it is approved.

By pressing the "Submit Application" button below, you agree to the above statement.  

To avoid delays in processing your request please provide us with the best method and time to contact. Best method of contact:
Home Phone      Mobile Phone      Work Phone      Email              What time of day is best to call:


Date:
Primary Signature:
Joint Signature: