P.O. Box 70, Hoosick Falls, NY 12090
Phone: (518) 686-4504 | Fax: (518) 686-7685
85 Washington Avenue, Bennington, VT 05201
Phone: (802) 445-0161 | Fax: (802) 445-0165

Loan Application

* Denotes required field.

Applicant Information

Employment Information

Complete if current employment is less than 2 years:

If you would like us to include other sources of income, please discuss this with our Loan Officers. Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Personal References*

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?*
Would you like to purchase Credit Life Insurance?*
Would you like to purchase GAP Insurance? (Cost is $250.00 and can be financed)*
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 repossession in the last 7 years?*
Are you a co-applicant/endorser on any loan or contract?
If yes, for whom and what is the monthly obligation?
Are you responsible for alimony, child support or maintenance payments?
If yes, for whom and what is the monthly obligation?
Do you currently have any outstanding judgements?*
How would you prefer to be contacted?*

Comments

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. Also for the purpose of reviewing the account, increasing the credit line on the account, or for the purpose of taking collection action on the account or for other legitimate purposes associated with the account. 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.