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LoanLiner
Application
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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 (AZ, AX, IS, 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: If you are applying with another person, complete the
Applicant and Other sections.
Guarantor: Complete the Other section if you are a guarantor
on an account/loan. |
Check
below to indicate the type of account(s) and type of credit for which you
are applying. Married Applicants may apply for a separate account. |
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Applicant: |
Other:
Co-Applicant
Spouse
Guarantor |
Name
(first,last,initial):
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Name
(first,last,initial):
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Mother's
Maiden Name:
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Mother's
Maiden Name:
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Account
Number:
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Account
Number:
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Social
Security Number:
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Social
Security Number:
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Driver's
License Number/State:
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Driver's
License Number/State:
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List
Ages of Dependents Not Listed By Other Applicant (exclude self):
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List
Ages of Dependents Not Listed By Other Applicant (exclude self):
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Birth
Date:
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Birth
Date:
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Home
Phone:
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Home
Phone:
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Business
Phone/Ext.:
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Business
Phone/Ext.:
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E-mail
Address :
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E-mail
Address :
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Present
Address (street, city, state, zip):
Years at this address:
Own
Rent |
Present
Address (street, city, state, zip):
Years at this address:
Own
Rent |
Previous
Address (street, city, state, zip):
Years at this address:
Own
Rent |
Previous
Address (street, city, state, zip):
Years at this address:
Own
Rent |
Complete
for joint credit, secured credit or if you live in a community property
state:
Married
Separated
Unmarried (single, divorced, widowed) |
Complete
for joint credit, secured credit or if you live in a community property
state:
Married
Separated
Unmarried (single, divorced, widowed) |
Employment/Income |
Employment/Income |
Name
of Employer:
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Name
of Employer:
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Address
of Employer:
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Address
of Employer:
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Title/Grade:
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Title/Grade:
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Start
Date:
Hours at Work:
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Start
Date:
Hours at Work:
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Supervisor's
Name:
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Supervisor's
Name:
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If
self-employed, type of business:
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If
self-employed, type of business:
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Notice:
Alimony, child support, or separate maintenance income need not
be
revealed if you do not choose to have it considered.
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Employment
Income:
$
per
Net
Gross |
Employment
Income:
$
per
Net
Gross |
Other
Income:
$
per
Net
Gross
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Other
Income:
$
per
Net
Gross |
Military:
Is duty station transfer expected during next year?
Yes
No
If yes, where?
Ending/Separation date:
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Military:
Is duty station transfer expected during next year?
Yes
No
If yes, where?
Ending/Separation date:
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If employed
less than five years:
Name of Previous
Employer:
Address of Previous
Employer:
Start Date:
End Date:
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If
employed less than five years:
Name of Previous
Employer:
Address of Previous
Employer:
Start Date:
End Date:
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Applicant
Reference - Please provide the following information on the nearest
relative not living with you: |
Other
Reference - Please provide the following information on the nearest
relative not living with you: |
Name:
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Name:
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Address:
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Address:
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Relationship:
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Relationship:
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Home
Phone:
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Home
Phone:
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What
You Owe |
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Other
Information About You |
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State
Law Notices |
Ohio Residents
Only: The Ohio laws against discrimination require that all creditors
make credit equally available to all creditworthy customers, and that
credit reporting agencies maintain separate credit histories on each individual
upon request. The Ohio Civil Rights Commission administers compliance
with this law.
Wisconsin Residents Only: (1) No provision of any marital property
agreement, unilateral statement under Section 766.59, or court decree
under Section 766.70 will adversely affect the rights of the Credit Union
unless the Credit Union is furnished a copy of the agreement, statement
or decree, or has actual knowledge of its terms, before the credit is
granted or the account is opened. (2) Please sign if you are not
applying for this account or loan with your spouse. The credit being applied
for, if granted, will be incurred in the interest of the marriage or family
of the undersigned.
____________________________________________________________________
Signature for Wisconsin Residents Only
________________________________
Date
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Signatures |
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