Secure Loan Application
421 - 11th Avenue South, Nampa, ID  83653
Phone: (208) 466-9455 • Fax: (208) 466-5615

1. Member Number

You must qualify to be a member of Mountain Gem Credit Union member to apply.
2 .Type Of Loan Applying For
2.1 - Type
2.2 - Please select which branch office you would like your loan application forwarded too:
3. Loan Terms
3.1 - Are you submitting individually or jointly?
3.2 - Desired loan amount: $
3.3 - Loan Purpose:
3.4 - If required will you provide collateral to secure this loan?
   3.4a - If yes please describe collateral:
(ie., yr, make, model)
VIN# If Available
3.5 - Method of Payment:
4. Primary Applicant
4.1 - Name:
First: Middle: Last: Suffix:
4.2 - Social Security Number:

555-55-5555
  4.3 - Date of birth:

mm/dd/yy
4.4 - What is your e-mail address?
(Re-enter your e-mail address)
4.5 - Home Phone Number:
555-555-5555
4.6 - Cell Phone Number:
555-555-5555
4.7 - What is your home address?
Street: City: State: Zip:
4.8 - Rent/Own/Buying:
   4.8a - Payment Amount:
4.9 - Time at residence:
4.10 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
If Applying For An Individual Loan Click Here

5. Joint Applicant
5.1 - Joint Applicant Type:   
5.2 - Name:
First: Middle: Last: Suffix:
5.3 - Social Security Number:

555-55-5555
5.4 - Date of birth:

mm/dd/yy
5.5 - What is your e-mail address?
(Re-enter your e-mail address)
5.6 - Home Phone Number:
555-555-5555
5.7 - Cell Phone Number:
555-555-5555
5.8 - What is your home address?
Street: City: State: Zip:
5.9 - Rent/Own/Buying:
   5.9a - Payment Amount:
5.10 - Time at residence:
5.11 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
 
6. Employment Information - Applicant
6.1 - Current employer:
6.2 - Title or position:
6.3 - Are you self employed?
  6.3a - Type of Business
6.4 - Business phone number:
ext.
555-555-5555
6.5 - Date Started Position:
mm/dd/yy
6.6 - Previous Employer?
  6.6a - Length Of Employment :
(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.)
6.7 - Salary: $ .00
6.8 - Other income: $ .00
  6.9a - Source of income:
If Applying For An Individual Loan Click Here

7. Employment Information - Joint Applicant
7.1 - Current employer:
7.2 - Title or position:
7.3 - Are you self employed?
  7.3a - Type of Business:
7.4 - Business phone number:
ext.
555-555-5555
7.5 - Date Started Position:
mm/dd/yy
7.7 - Previous Employer?
  7.6a - Length Of Employment :
(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.)
7.8 - Salary: $ .00
7.9 - Other income: $ .00
  7.9a - Source of income:
 
8. Debts & Assets
8.1 - Please tell us about your assets:
  8.1a - List Financial Institutions, Savings:

  8.1b - List Financial Institutions, Checking:

8.2 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
8.3 - Have you filed for bankruptcy?
  8.3a - Has this bankruptcy been discharged over four years ago?
  8.3b - (If less than four years) What year was the bankruptcy discharged?
8.4 - Are you co-maker/endorser on any loan not listed above?
  8.4a - If yes then for whom?
  8.4b - If yes then to whom?
8.5 - Are you a U.S. citizen or permanent resident alien?
9. References
9.1 - Nearest Relative NOT Living with you:
  9.1a - Name:
First: Middle: Last: Suffix:
  9.1b - Home Phone Number:
555-555-5555
  9.1c - What is their home address?
Street: City: State: Zip:
  9.1d - What is the relationship?
10. References
10.1 - Nearest Friend NOT Living with you:
  10.1a - Name:
First: Middle: Last: Suffix:
  10.1b - Home Phone Number:
555-555-5555
  10.1c - What is their home address?
Street: City: State: Zip:
  10.1d - What is the relationship?
 
11. Comments

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 and 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.

Note: A current wage stub showing year-to-date information, or other income documentation will be required for loan processing. Please fax this to (208) 466-5615 after submitting your loan application.

By pressing the "Submit Application" 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.


   
Submit Application