Secure Loan Application

Step 1 of 7

Type of Loan Applying For

Loan Type

Requested Amount ($)

Purpose Of Loan (If Auto Loan Please List Make/Model/Year)

Requested Term for Loan

Check here if you have a trade in.

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 or Credit Disability Coverage

Guaranteed Asset Protection (GAP) for Auto Loans

Applicant Information

First Name

Last Name

Account #

Social Security #

Date of Birth

Email Address

Number of Dependents

Do You Pay Child Support/Alimony?

Yes No

If Yes, How Much?

Have you filed for bankruptcy?

Yes No

If yes, was it more than 10 years or less than 10 years.

We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.

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

Primary Phone

Secondary Phone

Street Address

City

State

Zip Code

Current Address since

Rent / Own

Payment ($)

If less than 3 years:

Enter Previous Address

Number of months at previous address:

Number of Months

Joint Applicant Information

Is there a joint applicant for this loan?

Yes

First Name

Last Name

Account #

Social Security #

Date of Birth

Email Address

Number of Dependents

We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.

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

Primary Phone

Secondary Phone

Street Address

City

State

Zip Code

Current Address since

Rent / Own

Payment($)

If less than 3 years:

Enter Previous Address

Number of months at previous address:

Number of months

Employment Information

Applicant Employer's Name

Employer Phone #

Position

Date Hired

Hourly / Salary ($)

Hours Per Week Worked

Other Income/Month ($)

Other Income Source

Previous Job Start Date

Previous Job End Date

Previous Employer's Name

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.

Joint Applicant Employment Information

No Joint Applicant Selected.

Provide A Reference

First Name

Last Name

Primary Phone

Relationship

Comments

Enter Additional Comments

Submit Application

The Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that administers compliance with this law concerning this credit union is the Federal Trade Commission, Denver Regional Office, Suite 2900, Denver, CO 80202.

By submitting this form, I hereby certify that all statements made are true and complete and submitted for the purpose of obtaining credit. I acknowledge receipt of the Equal Credit Opportunity Act Notice. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. I understand you will retain this application whether or not it is approved.