Secure Loan Application

1012 Thornburg Street, Huntington, WV 25701
Phone: 304-429-1213   •   Fax: 304-429-5998
Account Number Amount Requested Type Of Loan Applying For Term
If A Member $ Months
PRIMARY APPLICANT JOINT APPLICANT
Name: First, Middle, Last
Social Security #:

Date of Birth:
Marital Status:
What Is Your Email Address?
Home Phone #:
 Cell Phone #:
 
Name: First, Middle, Last
Social Security #:

Date of Birth:
Marital Status:
What Is Your Email Address?
Home Phone #:
 Cell Phone #:
HOME ADDRESS? HOME ADDRESS?
Street:
 City:
State:
 Zip:
Years At Address: Rent or Own:
Monthly Housing Payment: $
 
Street:
 City:
State:
 Zip:
Years At Address: Rent or Own:
Monthly Housing Payment:  $
EMPLOYMENT EMPLOYMENT
Current Employer:
 Business Phone:
Job Title:
Date of Hire (MM/DD/YY):
(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.)
Gross Salary: $
Frequency:
Other Income: $
Frequency:
Source Of Income:
 
Current Employer:
 Business Phone:
Job Title:
Date of Hire (MM/DD/YY):
(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.)
Gross Salary: $
Frequency:
Other Income: $
Frequency:
Source Of Income:
REFERENCE REFERENCE
Nearest Relative:
Relationship:
Phone:
Address:
 
Nearest Relative:
Relationship:
Phone:
Address:
OTHER INFORMATION
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 Judgments Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?
Do You Have An Obligation To Pay Alimony/Child Support?
  If Yes, Amount $  per
PAYMENT METHOD
I Would Like A Payment Booklet.
I Would Like Payroll Deduction.
I Would Like The Payment Transferred From My Account On The Day It Is Due.
  Account Number:
CREDIT INSURANCE DESIGNATION
Yes No  
I Would Like Credit Life Insurance On This Loan. (Joint/Single)
I Would Like Credit Disability Insurance On This Loan. (Joint/Single)
 

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.

Note: A current wage stub showing year-to-date information, or other income documentation will be required for loan processing. Please fax this to your loan officer after submitting your 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.