1 College Circle, College Union 111
Geneseo, NY 14454
Phone: (585) 245-5700
Go Here for the
Co-borrower or Guarantor Application.                               Secure Loan Application

You are applying for a loan of $ to be repaid in months. The purpose of the loan is:
You are offering the following security for this loan:  
owned by:  
Information About You

Name: First, Middle, Last

  Date of Birth:
 
Social Security Number:
Drivers License Number:
Street Address:
Own Live with Parents
Rent Other
Years at this Address:
City:
  State:
 
Zip:
Home Phone Number:
Number of Dependents (excluding self):
  Age of Dependents:
 
Mother's Maiden Name:
What Is Your Email Address?
If you have lived at the above address less than two years, where did you live before?
Street Address:
Own Live with Parents
Rent Other
Years at this Address:
City:
State:
Zip:
Martial Status (Do not complete if you are applying for individual credit)
Married Separated Other (including single, divorced, or widowed)
Information About Your Employer
Employer:
Self Employed:
Yes No
Street Address:
Years with this Employer:
City:
State:
Zip Code:
Business Phone:
Position/Title:
Department:
Name of Supervisor:
Payroll NO.:
If you have worked for your present employer less than two years, where did you work before?
Previous Employer:
Self Employed:
Yes No
Street Address:
Years with this Employer:
City:
State:
Zip Code:
Business Phone:
Position/Title:
Department:
Name of Supervisor:
Payroll NO.:
Information About Your Income
Wages / Salary
$ per

Gross Take Home
If take-home is disclosed,
include all payroll deductions.

Hours Worked Per Week
Payroll Frequency
Monthly Bi-Weekly
Semi-Monthly Weekly
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income: $ Per Source
                            $ Per Source
If alimony, child support, or separate maintenance income is disclosed as "Other Income", are payments being received under
court order written agreement, or oral understanding?
Is any income listed in this entire section likely to be reduced in the next two years? Yes No, If "Yes",
explain:
References
Nearest Relative Not Living with You
Name and Relationship
Street Address
City
State
Zip Code
Telephone No.
Personal Friend (not a relative)
Name
Street Address
City
State
Zip Code
Telephone No.
       
Loan or Debt Creditor Account Number Original Amount/
Credit Limit
Current Balance Monthly Payment
Mortgage/Rent $ $ $
Second Mortgage/Home Equity $ $ $
Property Taxes (if not escrowed) $ $ $
Automobile $ $ $
Automobile $ $ $
Credit Card $ $ $
Credit Card $ $ $
Line-of-Credit $ $ $
Other $ $ $
 
Are you a co-maker, endorser, or guarantor on any debt obligation not listed above? Yes No.
If "Yes", provide debtor's name, current loan balance, and other details (including name and adress of any creditors):
Are there any unsatisfied judgements, garnishments or lawsuits pending against you? Yes No.
If "Yes" provide dollar amount and details:
Have you declared bankruptcy in the last 10 years? Yes No.
If "Yes" provide date and place of filing:
Have you ever been granted credit in another name? Yes No.
If "Yes", what was that name and where was the credit granted:
Are you presently liable for any alimony, child support, or separate maintenance payments? Yes No.
If "Yes", what is the amount and frequency of those payments:
Have you been denied credit in the last six months? Yes No.
 
Group Credit Insurance
Group credit insurance is voluntary and not a requirement of your loan.
To be eligible for Group Credti Life and/or Disability Insurance, your loan must mature before your 70th birthday. Additionally, to be eligible for Credit Disability Insurance, you must be actively at work and gainfully employed at least 20 hours per week. As part of the enrollment process, you may be asked to satisfactorily complete a separate Statement of Insurability.
Assuming your application for credit is approved and you are eligible for insurance, the Credit Union will disclose its total cost to you. You will also be asked to sign the request for coverage contained on the Personal Loan Plan Note, Security Agreement and Truth-In-Lending Disclosure form.
Indicate which credit insurance option(s) you desire:
Joint Credit Life Insurance. Single Credit Life Insurance. Single Credit Disability Insurance. No credit insurance.
 
Payroll Deduction and Automatic Transfer privileges
In many instances, loan obligations under the Personal Loan Plan can be repaid through voluntary payroll deduction made available to the Credit Union by your employer or by the automatic transfer of funds from a share account. The Credit Union will tell you if your loan can be repaid in these manners. Assuming it can be, check the appropriate box below:
I want voluntary payroll deduction.      I do not want voluntary payroll deduction.
I Authorize transfer of my loan payment(s) from Account No:

Representations & Authorizations.

You represent everything stated in this application is correct to the best of your knowledge. You further represent you have provided a complete listing of all your debts and obligations.

You authorize the Credit Union to investigate your credit record, verify your employment and income information, and answer questions regarding your credit history. You also authorize the Credit Union to obtain credit reports in connection with this application and for any update, renewal or extension of the credit received. If you request it 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 the National Credit Union Administration.

By pressing the "Submit Application" 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.