Landmark Home Page

Secure Loan Application Form

Danville Office
506 W. Fairchild, Danville, IL 61832
Phone: (217) 442-9005
Fax: (217) 442-9365

Westville Office
220 S State, Westville, IL 61883
Phone: (217) 267-7060
Fax: (217) 267-7064

Eastgate Office
176 Eastgate Ct., Danville, Il 61834
Phone: (217) 442-5690
Fax: (217) 442-6902

   
Type Of Loan Applying For

NOTICE: We are not affiliated with any branch of Landmark Credit Union in Wisconsin.

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Joint Applicant section about your spouse if:

  • Your spouse will use the account, or
  • 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 Joint Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Joint Applicant sections.

Type:

I agree to the Visa Credit Card Disclosure

Amount Requested: $ .00       Term: in months       Purpose/Collateral:
Credit Limit Requested $

Please tell us which branch you would like us to process your loan at:
Payment Method
I Would Like A Payment Booklet.
I Would Like Payroll Deduction.
I Would Like The Payment Transferred From My Account On The Day It Is Due.
Account Number:


Payment Protection

Yes
No

If you answer "yes", the credit union will disclose the cost to protect your loan. The protection is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions



Applicant Information
Applicant's Name:
Account #: (if member)
Social Security #:
Birthdate:
Email:
US Citizen: Yes No
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 #:
Cell Phone #:
Driver's License Number/State
Age of Dependents
Street Address:
City: State:
Zip #:
Monthly Housing Payment: $
Length at residence
Rent or Own:
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #: (if member)
Social Security #:
Birthdate:
Email:
US Citizen: Yes No
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 #:
Cell Phone #:
Driver's License Number/State
Age of Dependents
Street Address:
City: State:
Zip #:
Length at residence
Rent or Own:
Length at residence
If less than 3 yrs enter previous address:


Employment Information
Applicant Employer's Name:
Employment Status:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:
Previous Employer Name and Address (if employed less than five years)
Starting Date:
Ending Date:
Joint App. Employer's Name:
Employment Status:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:
Previous Employer Name and Address (if employed less than five years)
Starting Date:
Ending Date:
Military: Is duty station transfer expected during next year?
Where
Ending Date
Military: Is duty station transfer expected during next year?
Where
Ending Date

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
List Financial Institutions, Savings: Amount: List Financial Institutions, Checking: Amount:
 
Assets
LIST HOME AND ALL OTHER ITEMS YOU
OWN AND LOCATION OF PROPERTY

For Example:  Auto, Boat, Stocks, Bonds, Cash, Household Goods,Antiques & Collectibles, Real Estate, etc.
Market Value Pledged As Collateral For Another Loan
$
Yes No
$
Yes No
$
Yes No
$
Yes No
$
Yes No
 
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
Child Support Payments / Alimony $
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?


References
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


References (Co-Applicant Reference)
First Name: Middle Name: Last Name: Suffix:
   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? Home Phone Cell Phone Email
 
  Additional Comments:


Submit Application

CONSENT TO CONTACT

By executing this application, you agree we and/or our third-party providers, including debt collectors, may contact you by telephone or text message at any telephone number associated with your account, including wireless telephone numbers (i.e. cell phone numbers) which could result in charges to you, in order to service your account or collect any amounts owed to us, excluding any contacts for advertising and telemarketing purposes as prescribed by law. You further agree methods of contact may include use of pre-recorded or artificial voice messages, and/or use of an automatic dialing device. You may withdraw the consent to be contacted on your wireless telephone number(s) at any time by written notice to us at 506 W. Fairchild Street, Danville IL 61832, via phone at 217-442-9005 or 1-800-533-5615 or by any other reasonable means. If you have provided a wireless telephone number(s) on or in connection with any account, you represent and agree you are the wireless subscriber or customary user with respect to the wireless telephone number(s) provided and have the authority to give this consent. Furthermore, you agree to notify us of any change to the wireless telephone number(s) which you have provided to us.

STATE LAW NOTICE(S)

Notice to Nebraska Residents: A credit agreement must be in writing to be enforceable under Nebraska law. To protect you and us from any misunderstandings or disappointments, any contract, promise, undertaking, or offer to forebear repayment of money or to make any other financial accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must be in writing to be effective. Notice to New York Residents: New York residents may contact the New York State Department of Financial Services to obtain a comparative listing of credit card rates, fees, and grace periods. New York State Department of Financial Services: 1-800-342-3736 or www.dfs.ny.gov. Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. Notice to Wisconsin Residents: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned

CONSENSUAL SECURITY INTEREST

You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. Shares and deposits in an IRA or any other account that would lose special tax treatment under state or federal law if given as security are not subject to the security interest you have given in your shares and deposits. You may withdraw these other shares unless you are in default. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. For example, if you have an unpaid credit card balance, you agree we may use funds in your account(s) to pay any or all of the unpaid balance. By signing or otherwise authenticating below, you are affirmatively agreeing that you are aware that granting a security interest is a condition for the credit card and you intend to grant a security interest. You acknowledge and agree that your pledge does not apply during any periods when you are a covered borrower under the Military Lending Act. For clarity, you will not be deemed a covered borrower, and your pledge will apply, if: (i) you become obligated on a credit transaction or establish an account for credit when you are not a covered borrower; or (ii) you cease to be a covered borrower.

SUBMISSION

By submitting or otherwise authenticating below:

  1. You promise that everything you have stated in this application is correct to the best of your knowledge, and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection 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 crime to willfully and deliberately provide incomplete or incorrect information in this application.
  2. If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the Consumer Credit Card Agreement and Disclosure.