molex Home Page

Secure Loan Application Form

2222 Wellington Ct. Lisle, Illinois 60532
Phone: (630) 527-4280 | Fax: (630) 416-4918

   
Type Of Loan Applying For

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

  1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI)
  2. your spouse will use the account, or
  3. 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 Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: Each Applicant must individually complete the appropriate section below, If Co-Borrower is spouse of the Applicant,- mark the Co-Applicant box.

Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Are you applying for individual or joint credit ?: Individual    Joint

Type of Loan Applied For:

NOTE: You must have a minimum of 6 mos. employment to be eligible to apply for a vehicle/secured loan,
2 yrs. for a signature loan, or 5 yrs. for a premium personal loan.
Please fax a copy of your most recent paycheck stub to our office @ (630) 416-4918.

Signature (up to $5000)     Premium Personal (up to $10,000)     New Car     Used Car

Boat     Motorcycle    Share Secured    Stock Secured    Other:
*If you are applying for a vehicle loan you must fax a copy of your dealer's purchase agreement (630) 416-4918
Amount Requested: $ .00
Purpose:
Desired Length of Repayment (mos):

Method of Payment:
Payroll Deduction (if current Molex employee) Payment Books (if employed elsewhere)



Applicant Information
Applicant's Name:
Account #:
Social Security #:
Work Email:
Home Email:
US Citizen: Yes No
Birthdate (MM/DD/YY):
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 #:
Work Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #:
Social Security #:
Work Email:
Home Email:
US Citizen: Yes No
Birthdate (MM/DD/YY):
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 #:
Work Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:


Employment Information
EMPLOYMENT AND INCOME: In order to expedite the processing of your loan application, please fax a copy of your most recent paycheck stub to (630) 416-4918. If you have a joint applicant (cosigner) their paycheck stub must be faxed as well. If you are self employed or retired, you may fax a financial statement or tax return for income verification.
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Source of Other Income:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Source of Other Income:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:

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.


References (Nearest relative not living with you)
First Name: Middle Name: Last Name: Suffix:
Cell Phone Number:
  
555-555-5555
  Home Phone Number:
  
555-555-5555
  What is their home address?
Street: City: State: Zip:
   What is the relationship?


Debts & Assets
Applicant
Joint Applicant
Lender
Mo. Payment
Lender
Mo. Payment
Housing
Rent Own None
$ .00
Housing
Rent Own None
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Assets:
Description: Value:
    
Description: Value:
    
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?


Complete the following sections if you are applying for a vehicle loan:
Vehicle Make: Model:
Year: Engine Size: Mileage:
VIN or Serial#
Options or accessories to determine vehicle value:

Private Party Purchase:
Name of Seller:
Phone# of Seller:
Address:

Dealer Purchase:
Name of Dealer:
Phone# of Dealer:
Address:
If Private Party Purchase:
If private party still has a loan against the vehicle and the title is held by a leinholder:
Name of Finance Co. holding title:
Phone# of Finance Co.:
Account#:
Approximate payoff:
Address:
Additional Comments
 
 Additional Comments:


Submit Application

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, renewal or extension 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 federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

By pressing the "Submit Form" 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.