Healthcare Services Credit Union - Secure Loan Application

Exit Secure Loan Application

The lock or key at the bottom of your browser should be locked. If it is not, you may have followed an outdated link or used an incorrect URL to access this page. Click Here to reload this page as a secure document.

Please Enter your Email Address:

Type of Loan Applied For:
Personal (Signature) Visa Share/Certificate Secured Motorcycles New Car
Used Car  Recreational Vehicles Other:

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

Method of Payment:
Payroll Deduction Automatic Transfer from Savings Checking

Are you a U.S. Citizen?
Yes No

Have you ever had a judgment, bankruptcy, repossesion, or been a party in a lawsuit within the last 10 years?
Yes  No

Do you own your home or vehicle?
Home Value $ Vehicle(s) Value $

Applicant:

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

Joint Applicant:

Name:
Account #:
Drivers License Number:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Work Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Street:
City, State, & Zip:
Employment and Income: In order to expedite the processing of your loan application please fax your paystub copies to (423) 242-1940, Attention: Loan Department. If self-employed or retired, financial statement or income tax returns will be needed.
Employer Name:

Employer Address (City & State only):

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

Employer Address (City & State only):

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 is less than 2 years:
Previous Employers Name:

Years Employed:

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

Years Employed:
 

References:

Nearest Relative NOT Living with you:
   Name:
  First: Middle: Last: Suffix:
Home Phone Number:
555-555-5555
What is their home address?
  Street: City: State: Zip:
 What is the relationship?
Personal Friend:
   Name:
  First: Middle: Last: Suffix:
Home Phone Number:
555-555-5555
What is their home address?
  Street: City: State: Zip:

CREDIT INFORMATION
Please list all open Accounts with a balance.
Creditor Monthly
Payment
Housing
Rent Own
Creditor Monthly
Payment
Housing
Rent Own
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

VISA Classic 12.99%

Credit Line is $500.00 - $10,000.00

VISA Platinum
8.99%

Credit Line is
$1,000.00 - $15,000
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 - $20.00
  • Late Payment Fee - $25.00
  • Returned Check Fee - $20.00
  • Cash Advance Transaction Fee - $2.00
  • New or Replacement Card Fee - $10.00
  • Card Recovery Fee - $65.00
  • Balance Transfer Fee - NONE
  • Documentation Fee - $10.00
  • Emergency Cash or Card Replacement Fee (for premium cards only) - $45.00
    1-800-VISA-911

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.
 
Privacy Policy
 © 2002 Healthcare Services Credit Union