Secure Loan Application
500 E. Wilson Ave., Glendale, CA 91206
Phone: (818) 548-3976  •  Fax: (818) 545-7826

Member Number:
LOAN INFORMATION
Is this your first loan from us? Yes No
Amount/Credit Limit Requested: $
Approximate Time to Repay: How Many: Periods:
Loan Type:
Purpose of loan:
Security Offered: (for secured credit only)
Are you submitting individually or jointly?
 
PRIMARY APPLICANT
 
JOINT APPLICANT

Name: First, Middle, Last

Name: First, Middle, Last
Social Security Number:
Date of Birth:
Drivers License Number:
 
Social Security Number:
Date of Birth:
Drivers License Number:
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:
Monthly Housing Payment: $   Monthly Housing Payment:  $
Current Employer:
Business Phone:
 
Current Employer:
Business Phone:
Length Of Employment:   Length Of Employment:
Gross Salary: $       Gross Salary: $    
Frequency:   Frequency:
Other Income: $   Other Income: $
Frequency:   Frequency:
Source Of Income:   Source Of Income:
 
DEBTS & ASSETS
(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.)
 
 
List Financial Institutions, Savings: Amount:
 
List Financial Institutions, Checking: Amount:
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
 
Have you ever filed for bankruptcy?
Are you a U.S. citizen or permanent resident alien?
Is your income likely to decline in the next 2 years?
Are you a co-maker/endorser on any loan not listed above?
PAYMENT PROTECTION COVERAGE

Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Single Credit Disability/Single Credit Life
Single Credit Disability
Single Credit Life Insurance
Joint Credit Life Insurance
Rejected

GAP Insurance

ADDITIONAL NOTES
REFERENCES
Nearest Relative NOT Living with you:
 Name:
First: Middle: Last: Suffix:
Home Phone Number:
What is their home address?
Street: City: State: Zip:
What is the relationship?

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. 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 "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.