Secure Loan Application Form

817 W. Lincoln Hwy. Ste.E. DeKalb, IL 60115 
Phone: (815) 753-1911 | Fax: (815) 753-7405
NMLS #486789

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. 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.
New Auto Loan
Used Auto Loan
Recreational Vehicle
      (Boat, Camper, ATV, Motorcyle)
Personal /Signature Loan 		Home Equity Line of Credit
Home Equity Loan
Overdraft Line of Credit
Share Secured Loan
 Mini Loan
Debt Consolidation Loan
Signature Line of Credit

Purpose of Loan:

Requested Amount: $ .00

Applicant Information
Applicant's Name:
Account #:
Driver License #:
Social Security #:
Birthdate (MM/DD/YYYY):
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:
Email:
Home Phone #:
Mobile Phone #:
Work Phone #:
Street Address:
City: State:
Zip Code:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Other Applicant's / Guarantor Name:
Account #:
Driver License #:
Social Security #:
Birthdate (MM/DD/YYYY):
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:
Email:
Home Phone #:
Mobile Phone #:
Work Phone #:
Street Address:
City: State:
Zip Code:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:

Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Department:
Supervisor:
Position:
Date Hired (MM/DD/YYYY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Department:
Supervisor:
Position:
Date Hired (MM/DD/YYYY):
Monthly Gross Income ($):
Other Income ($): per Month
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.

We will need to verify your income. If you are an NIU employee, please fill out an NIU Human Resources Income Verification form. All other members please provide verification of income (2 recent pay stubs, copies of bank statements indicating direct deposits, etc.)

Debts & Assets
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Other Assets:
     Auto Year: Auto Make: Model Vehicle:  
     $
     Auto Year: Auto Make: Model Vehicle:  
     $
  Applicant Joint Applicant
Have you ever filed for bankruptcy or had debt adjustment under a Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesed in the last 7 years?
   Is your income likely to decline in the next two years?

Are you a co-maker/endorser on any loan not listed above?
   If yes, then for whom?
   If yes, then to whom?

Are you a U.S. citizen or permanent resident alien?

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

 
References
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?

Contact Method
  How would you prefer to be contacted? Home Phone Work Phone Mobile Phone Email
  Additional Comments:

Submit Application
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 768.59, 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 spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

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.