Please Enter your Email Address:

Complete for joint credit, secured credit or if you live in a community property state:
Married Separated Unmarried (Single, Divorced, Widowed)

Type of Loan Applied For:
Vehicle Loan Snowmobile/ATV Motorcycle Boat/Personal Watercraft
RV/Travel Trailer/Camper Personal Signature Other:

Amount applied for: $
Purpose: New Purchase Used Purchase Refinance Other
Desired Length of Repayment: 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years

Method of Repayment
Cash
Payroll Deduction
Automatic Transfer From    Savings    Checking

Payment Protection Plan:
Would you like to purchase Credit Life Insurance?

Single Credit Life (Approximately $.62 per $1,000)
Applicant Co-Applicant
Joint Credit Life (Approximately $.98 per $1,000)
None

Would you like to purchase Credit Disability Insurance?

Single Disability (Approximately $2.34 per $1,000)
Applicant Co-Applicant
Joint Disability (Approximately $4.45 per $1,000)
None

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Applicant: Name: Account #: Social Security #: Birthdate (MM/DD/YY): Home Phone #: Cell Phone #: Present Address: Street: City: State & Zip:	Joint Applicant: Name: Account #: Social Security #: Birthdate (MM/DD/YY): Home Phone #: Cell Phone #: Present Address: Street: City: State & Zip:
Employment and Income: Proof of income is required. If self-employed a financial statement or income tax returns will be needed. Please fax or email this information to the Credit Union after this loan application is submitted.
Employer Name: Employer Phone #: City of Employer: Position: Length of Employment: Monthly Gross Income: $ Other Income: $ per Month	Employer Name: Employer Phone #: City of Employer: Position: Length of Employment: Monthly Gross Income: $ Other Income: $ per Month
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.
Complete if current employment is less than 2 years: Previous Employers Name: Years Employed:	Complete if current employment is less than 2 years: Previous Employers Name: Years Employed:

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Credit Information
Please list all open Accounts with a balance.

Applicant Creditor Monthly Payment Housing Rent Own None	Joint Applicant Creditor Monthly Payment Housing Rent Own None
These questions must be answered. If any answers are a yes, please explain: 1. Are there any outstanding legal judgments against you? Yes No 2. Have you ever any had personal property repossessed Yes  No 3. Have you ever filed for bankruptcy. Yes No                If yes:   Chapter 7 Chapter 13 4. Are you a party in a lawsuit? Yes No 5. Do you have other obligations such as child support, alimony, or similar Liabilities? Yes No Explanation: 6. Are you a cosigner or a guarantor on any loan not listed above? Yes No Explanation:
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. By pressing the "Send Request" 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.