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

Loan Information

Applicant Information

Applicant's Present Address
Applicant's Previous Address

Complete if present address is less than 3 yrs.

Applicant's Employment Information

Applicant's Present Employer

Whole Dollars. If you would like us to include other sources of income, please discuss this with our Loan Officers. Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Applicant's Previous Employer

Complete if current employment is less than 2 years.

Applicant's Other Income

Part-Time Income / 2nd Income per Month

Applicant Personal References

Please provide two references.

Comments

You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, 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 NCUA.