208 W. Jefferson St.,  Boise, Id. 83702
Phone: (208) 275-0069  •  Fax: (208) 275-0032
Secure Loan Application
1. Member Number (Not required for Mortgage Loans)
 
2 .Type Of Loan Applying For (Mortgage: skip to section 5)
Auto Loan
            Purchase
            Refinance
VISA Credit Card    Visa Disclosure»
Mortgage
            Purchase
            Refinance
Personal Loan
            Purpose:
Savings Secured
Overdraft Protection
 
3. Payment Protection Plan
3.1 Would you like to purchase GAP Insurance?
Yes
No

3.2 Would you like to purchase Single Credit Disability Insurance? ($1.40 per $1000 per month)
Yes (Primary Member Only)
None
 
4. Loan Terms
4.1 - Are you submitting individually or jointly?
4.2 - Desired loan amount: $
4.3 - Repayment term:
4.4 - What is the value of the collateral? $ .00
  Year: Make: Model: Miles: VIN#:
4.5 - Desired mortgage term?
 
5. Primary Applicant
5.1 - Name:
First: Middle: Last: Suffix:
5.2 - Marital Status: Single Married Other
5.3 - Social Security Number:

555-55-5555
  5.4 - Date of birth:

mm/dd/yy
5.5 - Mother's Maiden Name:
5.6 - What is your e-mail address?
(Re-enter your e-mail address)
5.7 - Home Phone Number:
555-555-5555
5.8 - What is your home address?
Street: City: State: Zip:
5.9 - Rent/Own:
5.10 - Time at residence:
5.11 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
If Applying For An Individual Loan Click Here

6. Joint Applicant
6.1 - Joint Applicant Type:   
6.2 - Name:
First: Middle: Last: Suffix:
6.3 - Social Security Number:

555-55-5555
6.4 - Date of birth:

mm/dd/yy
6.5 - What is your e-mail address?
(Re-enter your e-mail address)
6.6 - Home Phone Number:
555-555-5555
6.7 - What is your home address?
Street: City: State: Zip:
6.8 - Rent/Own:
   6.8a - Payment Amount:
6.9 - Time at residence:
6.10 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
 
7. Employment Information - Applicant
7.1 - Current employer:
7.2 - 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     Net Gross
7.7 - Other income: $ .00
  7.7a - Source of income:
If Applying For An Individual Loan Click Here

8. Employment Information - Joint Applicant
8.1 - Current employer:
8.2 - Position:
8.3 - Are you self employed?
  8.3a - Type of business:
8.4 - Business phone number:
ext.
555-555-5555
8.5 - 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.)
8.6 - Salary: $ .00     Net Gross
8.7 - Other income: $ .00
  8.7a - Source of income:
 
9. Debts
9.1 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
9.3 - Have you filed for bankruptcy?
  9.3a - Has this bankruptcy been discharged over four years ago?
  9.3b - (If less than four years) What year was the bankruptcy discharged?
9.4 - Are you co-maker/endorser on any loan not listed above?
  9.4a - If yes then for whom?
  9.4b - If yes then creditor name?
9.5 - Are you a U.S. citizen or permanent resident alien?
   
10. References
10.1 - Nearest Relative NOT Living with you:
  10.1a - Name:
First: Middle: Last: Suffix:
  10.1b - Home Phone Number:
555-555-5555
  10.1c - What is their home address?
Street: City: State: Zip:
  10.1d - What is the relationship?
   
11. Mortgage Applications only:
INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
Borrower: I do not wish to furnish this information. Co-Borrower: I do not wish to furnish this information.
Ethnicity: Ethnicity:
Race: Race:
Sex: Sex:
This information was provided by the applicant and submitted via e-mail or the Internet.
Applications will be reviewed and processed by:
Sira Hiatt NMLS#1469935
Health Care Idaho Credit Union NMLS#779976
208 W. Jefferson Street
Boise, ID 83702

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 "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.
   

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