Secure Loan Application
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Please Enter your Email Address:

Please Enter your Home Phone Number:

Do not complete this next item if your application is for individual unsecured credit.
Married Separated Unmarried (Single, Divorced, Widowed)

Type of Loan Applied For:
Personal (Signature) VISA Credit Card Share Secured Unsecured Line of Credit New Car
Used Car Other:

Amount applied for: $
Purpose:
Desired Length of Repayment (months):

Method of Payment:
Coupons Payroll Deduction Direct Deposit

Are you interested in having your loan protected?:
Yes
No
If you answer "yes", the credit union will disclose the cost to protect your loan. The credit insurance is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.

Nearest Relative Not Living With You:
Name: Phone:

References:
Name: Phone:
Address:


Name: Phone:
Address:

Applicant:

Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:

Joint Applicant:

Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Employment and Income: In order to expedite the processing of your loan application please fax your paystub copies to (217) 222-5480, Attention: Loan Department. If self-employed or retired, financial statement or income tax returns will be needed.
Employer Name:

Employer Phone #:
Employer Address:

Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month		 Employer Name:

Employer Phone #:
Employer Address:

Position:
Date Hired (MM/DD/YY):
Monthly Gross Income: $
Other Income: $ per Month
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.
Complete if current employment is less than 2 years:
Previous Employers Name:

Years Employed: 		Complete if current employment is less than 2 years:
Previous Employers Name:

Years Employed:

Credit Information

Please list all open Accounts with a balance.
Creditor Monthly
Payment
Housing
Rent Own None
Creditor Monthly
Payment
Housing
Rent Own None
These questions must be answered. If any answers are a yes, please explain:

1. Do you have other loan applications pending at other financial institutions? Yes No

2. Are there any outstanding legal judgments against you? Yes No

3. Have you ever filed for bankruptcy or had a debt adjustment plan Confirmed under Chapter 13? Yes No

4. Are you a party in a lawsuit? Yes No

5. Is your status other than U.S. Citizen or Permanent Resident Alien? Yes No

6. Do you have other obligations such as child support, alimony, or similar Liabilities? Yes No

7. Are you a co-maker, cosigner, or a guarantor on any loan not listed above? Yes No

Explanation:



Are there any other assets, liabilities, obligations or considerations that we should know about in reviewing this application?
Yes No

If yes please explain:

VISA Credit Card Disclosure
Annual
Percentage
Rate 		Grace period Method of
Computing
the Balance 		Annual Fee Minimum
Finance
Charge 		Transaction
Fee for
Purchases 		Other Charges
9.9% (Periodic rate used to compute the Finance Charge is .825% per month.) Purchases-25 days Cash Advances accrue interest from the date they are posted to the account. Average Daily Balance Method (including new purchases). NONE NONE NONE

Over-the-Credit-Limit Fee - $25.00

Late Payment Fee - $25.00 after 10 days

Returned Check Fee - $15.00

Document Copy Fee - $10.00

Card Replacement Fee - $10.00

Card Recovery Fee - $65.00

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 "Send 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.

   

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