SECURE LOAN APPLICATION
910 Main Street, Grand Junction, CO 81501
Phone: (970) 243-1370 • Fax: (970) 241-3010
1. Member Number

Members please enter your member number, Non-Members please enter 1234.
 
2 .Type Of Loan Applying For
 
3. Loan Terms
3.1 - Are you submitting individually or jointly?
3.2 - Desired loan amount: $
3.3 - Loan Term Desired:
3.4 - If required will you provide collateral to secure this loan?
   3.4a - If yes please describe collateral:
(ie., yr, make, model)
3.5 - Method of Payment:
3.6 - Would you like to purchase Credit Life Insurance?
 Single Credit Life (Only Available for Applicant)
Joint Credit Life
None 
3.7 - Would you like to purchase Single Credit Disability Insurance?
 Yes (Primary Member Only)
None
 
4. Primary Applicant
4.1 - Name:
First: Middle: Last: Suffix:
4.2 - Social Security Number:

555-55-5555
  4.3 - Date of birth:

mm/dd/yy
4.4 - What is your e-mail address?
(Re-enter your e-mail address)
4.5 - Home Phone Number:
555-555-5555
4.6 - What is your home address?
Street: City: State: Zip:
4.7 - Rent/Own/Buying:
   5.7a - Payment Amount:
4.8 - Time at residence:
4.9 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
If Applying For An Individual Loan Click Here

5. Joint Applicant
5.1 - Joint Applicant Type:   
5.2 - Name:
First: Middle: Last: Suffix:
5.3 - Social Security Number:

555-55-5555
5.4 - Date of birth:

mm/dd/yy
5.5 - What is your e-mail address?
(Re-enter your e-mail address)
5.6 - Home Phone Number:
555-555-5555
5.7 - What is your home address?
Street: City: State: Zip:
5.8 - Rent/Own/Buying:
   5.8a - Payment Amount:
5.9 - Time at residence:
5.10 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
 
6. Employment Information - Applicant
6.1 - Current employer:
6.2 - Title or position:
6.3 - Are you self employed?
  6.3a - Type of Business
6.4 - Business phone number:
ext.
555-555-5555
6.5 - Date Started Position:
mm/dd/yy
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
6.6 - Salary: $ .00
6.7 - Other income: $ .00
  6.7a - Source of income:
If Applying For An Individual Loan Click Here

7. Employment Information - Joint Applicant
7.1 - Current employer:
7.2 - Title or position:
7.3 - Are you self employed?
  7.3a - Type of Business:
7.4 - Business phone number:
ext.
555-555-5555
7.5 - Date Started Position:
mm/dd/yy
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
7.6 - Salary: $ .00
7.7 - Other income: $ .00
  7.7a - Source of income:
 
8. Debts & Assets
8.1 - Please tell us about your assets:
  8.1a - List Financial Institutions, Savings:

  8.1b - List Financial Institutions, Checking:

8.2 - Please tell us about your debts:
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
8.3 - Have you filed for bankruptcy?
  8.3a - Has this bankruptcy been discharged over four years ago?
  8.3b - (If less than four years) What year was the bankruptcy discharged?
8.4 - Are you co-maker/endorser on any loan not listed above?
  8.4a - If yes then for whom?
  8.4b - If yes then to whom?
8.5 - Are you a U.S. citizen or permanent resident alien?
 
9. References
9.1 - Nearest Relative NOT Living with you:
  9.1a - Name:
First: Middle: Last: Suffix:
  9.1b - Home Phone Number:
555-555-5555
  9.1c - What is their home address?
Street: City: State: Zip:
  9.1d - What is the relationship?

1. You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If 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. If 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. It 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.

2. If you are applying for a credit card, you understand that the use of your 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.

3. 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.

Note: A current wage stub showing year-to-date information or other income documentation will be required for loan processing. Please fax this to (970) 241-3010 after submitting your loan application.

By pressing the "Submit Application" 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.

Submit Application