Credit Card Loan Application
P.O. Box 70, Hoosick Falls, NY  12090
Phone: (518) 686-4504 • Fax: (518) 686-7685
1
Account Number - If You Are A Member Amount Requested Type Of Loan Applying For
$ Select Type Below..........
PRIMARY APPLICANT
  
JOINT APPLICANT

Name: First, Middle, Last

 Name: First, Middle, Last
Social Security Number:
 Date of Birth:
Marital Status:
 
Social Security Number:
 Date of Birth:
Marital Status:
What Is Your Email Address?
   What Is Your Email Address?
Home Phone Number:
 Cell Phone Number:
I Can Be Best Reached Via:
 
Home Phone Number:
 Cell Phone Number:
I Can Be Best Reached Via:
 
What Is Your Home Address?
Street: City:
  What Is Your Home Address?
Street: City:
State: Zip:
Years At Address:
 
State: Zip:
Years At Address:
Monthly Housing Payment: $   Monthly Housing Payment:  $
Current Employer:
 Business Phone:
Job Title:
Time On Job:
 
Current Employer:
 Business Phone:
Job Title:
Time On Job:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
 
Nearest Relative:   Nearest Relative:
Phone:   Phone:
Address:   Address:
PAYMENT PROTECTION PLAN

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.

Would you like to purchase Credit Life Insurance?
Single Credit Life
 Joint Credit Life
None
DEBTS & ASSETS
Please tell us about your assets:
  - Checking & Savings: $ .00
  - Market Value of Home you Own: $ .00
  - Other assets (excluding real-estate): $ .00
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
 
OTHER INFORMATION
(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.)
 
Are you responsible for alimony, child support or maintenance payments?
If Yes, The Amount?
Have You Filed For Bankruptcy? Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?

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 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 forceand effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature.

You understand that the use of your card will constitute acknowledgement 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.

By pressing the "Submit Application" button below, you agree to the above statement. You understand that we may require additional information to finalize our credit decision and your signature on additional documents prior to disbursing any credit proceeds.