Tri State Area FCU Home Page

Loan Application

P.O. Box 70, Hoosick Falls, NY  12090
Phone: (518) 686-4504 | Fax: (518) 686-7685

   
Type Of Loan Applying For
Check below to indicate the type of account(s) and type of credit for which you are applying.

Account / Loan: Individual    Joint

Where would you like to sign for your loan if Approved?

Select Type of Loan:    

If 'personal' loan type was selected please state a specific reason for this loan.

Amount Requested: $ .00    

Loan Term: in Months     

Repayment: Payroll Deduction Cash Military Allotment Automatic Payment



Applicant Information
Applicant's Name:
Account #:
Social Security #:
US Citizen: Yes No
Birthdate: (MMDDYYYY)
Email:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Years at address::
Own or Rent?
Monthly Housing Payment? $
Joint Applicant's Name:
Account #:
Social Security #:
US Citizen: Yes No
Birthdate: (MMDDYYYY)
Email:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Years at address::
Own or Rent?
Monthly Housing Payment? $


Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Position:
Length of time with Employer:
Monthly Gross Income
(Before Tax Deductions):
Other Income : per Month
Complete if current employment is less than 2 years:
Previous Employer's Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Position:
Length of time with Employer::
Monthly Gross Income
(Before Tax Deductions):
Other Income : per Month
Complete if current employment is less than 2 years:
Previous Employer's Name:
Yrs Employed:


Payment Protection Coverage
Check coverage(s) desired. The Credit Insurance is voluntary and does not affect your loan approval decision. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Would you like to purchase Credit Disability Insurance?

Single Disability       Joint Disability None
Would you like to purchase Credit Life Insurance?

Single Life Insurance       Joint Life Insurance       None
Would you like to purchase GAP Insurance? (Cost is $250)

Yes       No Thanks


Debts & Assets
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Outgoing Child Support Payments / Alimony $
Assets:
Checking and Savings Total: $
Other $
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?
Do you currently have any outstanding judgements?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?


References (Nearest relative not living with you)
First Name: Last Name:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?

Contact Method
  How would you prefer to be contacted? Cell Phone Home Phone Email
 
  Additional Comments:


Submit Application

You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify us in writing immediately.
You authorize the Credit Union to obtain credit reports and investigate your employment history in connection with this application for credit and for any update, renewal or extension 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 insured by NCUA.

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 additional information and documentation to finalize our credit decision and your signatures on additional documents prior to disbursing any credit proceeds.