4902 N Biltmore Lane, Ste 1545
Madison WI 53718-2148
Phone: 608-256-1001 or 800-752-0924   • Fax: 608-283-2845
Secure Loan Application
Member Number Amount Requested Type Of Loan Applying For Term
$ Months

You may apply for individual or joint credit, but check only one of the following options.
Individual Credit - unmarried applicant. Complete only the left hand column and other sections as they apply.
Individual Credit - married applicant. If both you and your spouse are residents of Wisconsin, complete both the left and right hand columns. If either you or your spouse are not Wisconsin residents, complete only the left hand column.
Joint Credit - with your spouse. Complete both the left and right hand columns and other sections as they apply.
Joint Credit - with another applicant or cosigner who is not your spouse. Each of you must complete a separate application. If both you and your spouse are Wisconsin residents incude information about your spouse in the right hand column.

Collateral (year, make, model, cyl.):
ID Number:

Method of Payment:
Coupons Payroll Deduction Automatic Transfer from Shares Drafts

     
PRIMARY APPLICANT
  
JOINT APPLICANT

Name: First, Middle, Last

 Name: First, Middle, Last
Social Security Number:
 Date of Birth:
 
Social Security Number:
 Date of Birth:
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:
 
State: Zip:
Monthly Housing Payment: $   Monthly Housing Payment:  $
 
Current Employer:
 Business Phone:
 
Current Employer:
 Business Phone:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
     
REFERENCES
Nearest Relative (Not Spouse):   Personal:
 
Phone:   Phone:
Address:   Address:
     
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.)
 

Payment Protection Plan:
Would you like to purchase Credit Life Insurance?
Single Credit Life (Only Available for Applicant)
None

Would you like to purchase Credit Disability Insurance?
Applicant
None

This section required by Wisconsin Law:
I certify that the credit being applied for,if granted, will be incurred or obtained during marriage and will be in the interest of the marriage or family.
I Agree Not Applicable

This statement is made in accordance with Wis. Stat. Sec. 766.55(1).
If this section applies, we are required by Wisconsin law to notify your spouse by mail if your loan is granted.

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 force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature. Security on one loan is security on any monies owed to the Credit Union.

PLEASE MAIL, FAX, OR BRING INTO TO OUR OFFICE YOUR MOST RECENT PAY CHECK STUB.

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.