Secure Loan Application Form

1100 Henderson St. Garrison Center Room D203
P.O. Box 7691. Arkadelphia, AR  71999-0001
Phone: (870) 230 – 5279 | Fax: (870) 230 – 5780



Member Number: You must be a member of the HSU Federal Credit Union to apply for a loan. There is a $15.00 application fee.

Individual Credit: You must complete the Applicant section about yourself and the other section about your spouse if:
1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI).
2. your spouse will use the account, or
3. you are relying on your spouse’s income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extant possible about the person on whose payments you are relying.

Joint Credit: Each applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.


Type Of Loan Applying For

New Auto Loan
Used Auto Loan
Recreational Vehicle (Boat, Camper, ATV, Motorcyle)

Personal Loan
Share Secured
Home Equity **Additional disclosures required
Requested Amount: $ .00

Debt Protection Coverage
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Single Death Coverage
Joint Death Coverage 		Single Disability Coverage GAP or GAP ADR
Mechanical Breakdown
None 		Tell Me More
Applicant Information
Applicant's Name:
Account #:
Social Security #:
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Mobile Phone #:
Email:
Street Address:
City:   State:
Zip #:
Current Address since: (MM/YY)
Own Rent
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #:
Social Security #:
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Mobile Phone #:
Email:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
Own Rent
If less than 3 yrs enter previous address:

Employment/Income
Applicant Employer's Name:
Employer Phone #:
Employer Address :
Position:
Supervisor:
Hours Worked:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Military Status:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address :
Position:
Supervisor:
Hours Worked:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Military Status:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
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.
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
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?
   Is your income likely to decline in the next two years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?
Are you a U.S. citizen or permanent resident alien?
 
Reference I
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
  
   What is their home address?
Street: City: State: Zip:
   What is the relationship?
 
Reference II
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
  
   What is their home address?
Street: City: State: Zip:
   What is the relationship?

Submit Application

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 to us accept your facsimile signature. You authorize use of any contact information contained herein to be used by the Credit Union for contact purposes only including cell phone numbers.

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. You authorize use of any contact information contained herein to be used by the Credit Union for contact purposes only including cell phone numbers.