Secure Loan Application

Step 1 of 7

Type of Loan Applying For

Loan Type

If other, enter type of loan

Purpose of loan/Collateral

Requested Amount ($)

Requested Term for Loan

Please select your loan officer:

Applying For *

I am applying for individual credit We are applying for joint credit

Applicant Information

First Name

Last Name

Account #

Social Security #

U.S. Citizen

Date of Birth

Email Address

Number of Dependents

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:

Marital Status

Primary Phone

Secondary Phone

Street Address

City

State

Zip Code

Current Address since

Rent Own

Payment ($)

If less than 3 years:

Enter Previous Address

Number of months at previous address:

Number of Months

Joint Applicant Information

Is there a joint applicant for this loan?

Yes

First Name

Last Name

Account #

Social Security #

U.S. Citizen

Date of Birth

Email Address

Number of Dependents

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:

Marital Status

Primary Phone

Secondary Phone

Street Address

City

State

Zip Code

Current Address since

Rent Own

Payment($)

If less than 3 years:

Enter Previous Address

Number of months at previous address:

Number of months

Employment Information

Applicant Employer's Name

Employer Phone #

Employer Address

Status

Position

Date Hired

Monthly Salary($)

Other Income/Month($)

Previous Job Start Date

Previous Job End Date

Previous Employer's Name

Other Income Source

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.

References

Nearest Relative not living with you

First Name

Last Name

Suffix

Primary Phone

Home Address

City

State:

Zip Code

Relationship

Comments

Submit Application

You agree that everything stated in this application is correct to the best of your knowledge. The Credit Union is authorized to investigate your creditworthiness, employment history, and to obtain a credit report to answer questions about their credit experience with you. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default. 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. Security on one loan is security on any monies owed to the Credit Union.

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

By pressing the "SUBMIT" button below, you agree to the above statement. You understand that we may require additional information to finalize our credit decision and your signature on additional documents prior to disbursing any credit proceeds.