Step 1 of 7

Type of Loan Applying For

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.

Applicant Information

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:

If less than 3 years:

Number of months at previous address:

Joint Applicant Information

Is there a joint applicant for this loan?

Employment Information

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.


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.