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:

Amount Requested: $ .00       Term: in months

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 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.
Credit Life Protection (Joint/Single)       None
Credit Disability Protection       None
GAP Protection (Available For Vehicles & RV's Only)       None


Applicant Information
Applicant's Name:
Account #: (if member)
Social Security #:
Email:
US Citizen: Yes No
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 #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Monthly Housing Payment: $
Current Address since: (MM/YY)
Rent or Own:
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #: (if member)
Social Security #:
Email:
US Citizen: Yes No
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 #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
Rent or Own:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:


Employment Information
Applicant Employer's Name:
Employer Phone #:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:
Joint App. Employer's Name:
Employer Phone #:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:

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

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.