Secure Loan Application
   
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
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.

Account Number Amount Requested Type Of Loan Applying For Term
If A Member $ Months
Please tell us which branch you would like us to process your loan at:
PRIMARY APPLICANT JOINT APPLICANT
Name: First, Middle, Last
Social Security #:

Date of Birth:

Marital Status:
What Is Your Email Address?
Home Phone #:
Cell Phone #:
 
Name: First, Middle, Last
Social Security #:

Date of Birth:

Marital Status:
What Is Your Email Address?
Home Phone #:
Cell Phone #:
HOME ADDRESS? HOME ADDRESS?
Street:
City:
State:
Zip:
Years At Address: Rent or Own:
Monthly Housing Payment: $
 
Street:
City:
State:
Zip:
Years At Address: Rent or Own:
Monthly Housing Payment:  $
EMPLOYMENT EMPLOYMENT
Current Employer:
Business Phone:
Job Title:
Date of Hire (MM/DD/YY):
(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.)
Gross Salary: $
Frequency:
Other Income: $
Frequency:
Source Of Income:
 
Current Employer:
Business Phone:
Job Title:
Date of Hire (MM/DD/YY):
(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.)
Gross Salary: $
Frequency:
Other Income: $
Frequency:
Source Of Income:
REFERENCE REFERENCE
Nearest Relative:
Relationship:
Phone:
Address:
 
Nearest Relative:
Relationship:
Phone:
Address:
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
OTHER INFORMATION
Have You Filed For Bankruptcy?
Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgments Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?
Do You Have An Obligation To Pay Alimony/Child Support?
  If Yes, Amount $  per
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 DESIGNATION
Yes No  
I Would Like Credit Life Protection On This Loan. (Joint/Single)
I Would Like Credit Disability Protection On This Loan.
I Would Like GAP Protection On This Loan. (Available For Vehicles & RV's Only)
 

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.

Note: A current wage stub showing year-to-date information, or other income documentation will be required for loan processing. Please fax this to (217) 442-9365 Danville & (217) 267-7064 Westville after submitting your loan application.

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.