PO Box 216, St Maries ID 83861
Phone: (208) 245-4231 • Fax: (208) 245-5341
  Secure Loan Application

Account Number - If You Are A Member Amount Requested Type Of Loan Applying For Term
$ Months

Payment Protection Plan
Would you like to purchase Credit Life Insurance?
Single Credit Life
Joint Credit Life
None

Do you want your loan protected for you and your family if you become disabled?
Yes
None

PRIMARY APPLICANT
 
JOINT APPLICANT

Name: First, Middle, Last

  Name: First, Middle, Last
Social Security Number:
Date of Birth:
 
Social Security Number:
Date of Birth:
What Is Your Email Address?
  What Is Your Email Address?
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:

 
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:

What Is Your Home Address?
Street: City:
  What Is Your Home Address?
Street: City:
State: Zip:
 
State: Zip:
Years At This Address:   Years At This Address:
Monthly Housing Payment: $   Monthly Housing Payment:  $

 
Current Employer:
Business Phone:
 
Current Employer:
Business Phone:
Position/Title:   Position/Title:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
Date Started Position:
mm/dd/yy
  Date Started Position:
mm/dd/yy
     
REFERENCES
Primary Applicant -
Nearest Relative (Not Living With You):
  Joint Applicant -
Nearest Relative (Not Living With You):
 
Phone:   Phone:
Address:   Address:
     
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
 
OTHER INFORMATION
(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.)
 
Have You Filed For Bankruptcy? Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?

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.

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) 245-5341 after submitting your loan application.

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.