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United Savings Credit Union
P.O. Box 2308
220 N. 10th St.
Fargo, North Dakota
(701)235-2832
CREDIT LINE ACCOUNT AND PERSONAL LOAN APPLICATION
Account # Applicant: Account # Co-Applicant: Date
Applicant Information
    1.If You live in a community property state, are You:
    Married Separated Unmarried (Single - Divorced - Widowed)

    2. Married applicants can apply for an individual loan. Indicate if you want an:
      Individual loan:
    Joint loan with your Spouse/Co-applicant

    3. Method of Payment
    Repayment:
    Payroll Deduction
    Cash
    Millitary Allotment
    Automatic Payment

    4. Frequency of Payment
    Weekly Bi-Weekly Monthly Hourly

    5. Complete Spouse/Co-Applicant Information only if:
      a.This is for a joint account with Your Spouse or other Co-applicant
      b.Your Spouse will use Your Account
      c. You are relying on Your Spouse's income as a source of repayment for the credit requested
      d. You live in a community property state(AZ,CA,ID,LA,NM,NV,TX,WA,WI) and Puerto Rico.
    Definitions
      Whenever used in this application the words You and Your refer to the Applicant(s) or Spouse/Co-Applicant and the words We, Us, and Our refer to the Lender.
Open-End Credit Applied For:
Signature Line of Credit
Limit Desired: $
Limit Desired: $
Limit Desired: $
Limit Desired: $
Other
Closed-End Credit Applied For:
Type: New Auto Used Auto Signature
Other(specify):
Amount Requested: $
Length of Repayment (Months)
Purpose:
Collateral:

Applicant
Spouse/ Co-Applicant
Name: Name:
Social Security #: Social Security #:
Birth Date (MM/DD/YYYY): Birth Date (MM/DD/YYYY):
Current Street Address: Current Street Address:
Years There: Years There:
City/State
,
City/State
,
Zip Code:
-
Zip Code:
-
Former Address(Complete if previous address is less than 3 years): Former Address(Complete if previous address is less than 3 years):
Years There: Years There:
Own Rent Pay Board
Own Rent Pay Board
Home Phone: Home Phone:
#of Dependents #of Dependents
Age of Dependents Age of Dependents
Name of Nearest Relative(Not living with you)
Address
Home Phone
Relationship
Name of Nearest Relative(Not living with you)
Address
Home Phone
Relationship

EMPLOYMENT AND INCOME Attach two most recent pay check stubs. If self employed check hereand mail in two years federal income tax returns.
Current Employer: Current Employer:
Start Date: Start Date:
Address of Employer: Address of Employer:
City/State
,
City/State
,
Zip Code:
-
Zip Code:
-
Monthly Income: Monthly Income:
Position: Position:
Work Phone: Work Phone:
Years There: Years There:
Previous Employer: Start Date:
Position: End Date:
Previous Employer: Start Date:
Position: End Date:

Notice: Alimony,child support or separate maintenance income need not be revealed if you do not have it considered.
Employment Income: $ Employment Income: $
Net Gross
Net Gross
Other Income:$ Other Income:$
Source: Source:
Annual Monthly Hourly
Annual Monthly Hourly

APPLICANT ASSETS AND DEPOSITS
WHAT YOU OWN: BANK (OR OTHER)NAME, ADDRESS ACCOUNT NO. INTEREST RATE APPROX.BAL
HOME
SAVINGS
CHECKING
OTHER(DESCRIBE)
CAR1 YR. MAKE MODEL BALANCE OWED:$
CAR2 YR. MAKE MODEL BALANCE OWED:$
HOMEOWNERS: PLEASE INDICATE NAMES ON DEED Purchase Price:$ approx. value

SPOUSE/CO-APPLICANT ASSETS AND DEPOSITS
WHAT YOU OWN: BANK (OR OTHER)NAME, ADDRESS ACCOUNT NO. INTEREST RATE APPROX.BAL
HOME
SAVINGS
CHECKING
OTHER(DESCRIBE)
CAR1 YR. MAKE MODEL BALANCE OWED:$
CAR2 YR. MAKE MODEL BALANCE OWED:$
HOMEOWNERS: PLEASE INDICATE NAMES ON DEED Purchase Price:$ approx. value

What You Owe CREDITOR NAME OTHER THAN THIS CREDIT UNION INTEREST RATE PRESENT BALANCE MONTHLY PAYMENT
APPLICANT OTHER
RENT
FIRST MORTGAGE
$ $
2ND MORTGAGE $ $
1ST AUTO LOAN $ $
2ND AUTO LOAN $ $
CHILD-CARE $ $
CHILD SUPPORT $ $
CREDIT CARD $ $
CREDIT CARD $ $
OTHER $ $
OTHER $ $
LIST ANY NAME UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED TOTALS $ $

Please answer the following questions, if a yes answer is given, explain in the section below. APPLICANT OTHER
1. HAVE YOU FILED A PETITION FOR BANKRUPTCY IN THE LAST 14 YEARS? YES NO YES NO
2.HAVE YOU EVER HAD ANY AUTO, FURNITURE OR PROPERTY REPOSSESSED? YES NO YES NO
3.ARE YOU A CO-MAKER OR CO-SIGNER ON ANY LOAN? YES NO YES NO
4.HAVE YOU EVER HAD CREDIT IN ANY OTHER NAME? YES NO YES NO
5. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGEMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT? YES NO YES NO
6.HAVE YOU ANY OBLIGATIONS NOT LISTED? YES NO YES NO
7.DO YOU HAVE ANY PAST DUE BILLS? YES NO YES NO
8. IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS? YES NO YES NO
EXPLANATION FOR (YES CHECKED) ABOVE:
VISA Credit Card Disclosure
Annual
Percentage
Rate
Grace period Method of
Computing
the Balance
Annual Fee Fee For Exceeding Credit Limit Minimun
Finance
Charge
Transaction
Fee for
Purchases
Other Fees
6.00% - 16.0%
Includes Cash Advance
and Balance Transfers
Purchases-25 days. Cash Advances accrue interest from the date they are posted to the account. Average Daily Balance Method (including new purchases). NONE $25.00 NONE NONE Late Fee - $25.00
(30 days or more late)
Over-the-Credit-Limit Fee - $25.00

NOTE: If You are applying for Credit Insurance, You authorize Us to add the required premiums to Your Account, charge a Finance Charge on the premiums at the rate which applies to Your Account, and forward such premiums to the Insurance Company.
X________________________________
Applicant Signature and Date
X________________________________
Co-Applicant Signature and Date

I (We) acknowledge and agree to the terms and conditions as outlined above.

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. Interest rates, terms of loan, and loan-to-value granted are determined by your credit worthiness. You do have the right to know your credit score in the event you receive less desirable credit terms. 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.

By pressing the "Send 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.

I (We) acknowledge and agree to the terms and conditions as outlined above.