Secure Loan Application
1705 Centennial Blvd #4, Springfield, OR 97477
Phone: (541) 746-6121 • Fax: (541) 746-4486
Account Number Amount Requested Type Of Loan Applying For Term
$ Months
PRIMARY APPLICANT
  
JOINT APPLICANT

Name: First, Middle, Last

 Name: First, Middle, Last
Social Security Number:
 Date of Birth:
 
Social Security Number:
 Date of Birth:
What Is Your Email Address?
   What Is Your Email Address?
Home Phone Number:
 Cell Phone Number:
I Can Be Best Reached Via:
 
Home Phone Number:
 Cell Phone Number:
I Can Be Best Reached Via:
What Is Your Home Address?
Street: City:
  What Is Your Home Address?
Street: City:
State: Zip:
 
State: Zip:
Monthly Housing Payment: $   Monthly Housing Payment:  $
 
Current Employer:
 Business Phone:
 
Current Employer:
 Business Phone:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
     
REFERENCES
Nearest Relative (Not Spouse):   Personal:
 
Phone:   Phone:
Address:   Address:
     
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
 
OTHER INFORMATION
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
 
Would you like to purchase Single Credit Disability Insurance?
 Yes None
   
Have You Filed For Bankruptcy? Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?

You agree that everything stated in this application is true and complete 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.  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.  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.

PLEASE MAIL, FAX, OR BRING INTO TO OUR OFFICE YOUR MOST RECENT PAY CHECK STUB.

By pressing the “Submit Application” button, you agree to the above statement.  You understand that we may require more information to finalize our credit decision and your signature on additional documents prior to disbursing and credit proceeds.