Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself. 

Please complete the Co-Applicant section about your spouse if:

  1. Your spouse will use the account, or
  2. You are relying on your spouse's income as a basis for repayment.

If you are relying on income from alimony, child support or separate maintenance, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING

Is this your first loan from us? yes no
Amount/Credit Limit Requested: $
Approximate Time to Repay: How Many? Periods:
Loan Type:
Security Offered:
(for secured credit only, not applicable to credit cards)
Type of Credit: Individual Joint

For Credit Cards, see Disclosure Table

PAYMENT PROTECTION COVERAGE Check if desired

Find out more about Payment Protection Insurance and why it's a better consumer value when offered through your credit union.

Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Yes No Do you want your loan protected for you and your family if you become disabled?
Yes No Do you want your loan protected for you and your family in the event of your death?

TELL US ABOUT YOURSELF

Applicant Co-Applicant
Name: Name:
CU Account #: CU Account #:
Social Security #: Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married Separated Unmarried (Single - Divorced - Widowed)		 Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:
Married Separated Unmarried (Single - Divorced - Widowed)
Driver's License #: State: Driver's License #: State:
Birth Date: Birth Date:
Home Phone:
Business Phone: 		Home Phone:
Business Phone:
Present Address:
Years There: Own Rent		 Present Address:
Years There: Own Rent
DEBTS DEBTS
Mortgage/Rent owed to: Mortgage/Rent owed to:
Balance (Mortgage only): Balance (Mortgage only):
Monthly Payment:
Current APR % (Mortgage only): 		Monthly Payment:
Current APR % (Mortgage only):
Person Responsible for Payment: Person Responsible for Payment:
INCOME INCOME
Employer: Employer:
Date Employed: Date Employed:
Income: $ Net Gross
Annual Monthly Bi-weekly Weekly		 Income: $ Net Gross
Annual Monthly Bi-weekly Weekly
Other Income: (Notice: Alimony,child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$ Annual MonthlyHourly		 Other Income: (Notice: Alimony,child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$ Annual MonthlyHourly

This information is accurate as of 6/14/99 and is subject to change after that date. Please contact the credit union for any changes to this information.

SIGNATURES: You promise that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision. By signing below, you agree to be bound by the terms of the agreement.

X________________________________
Applicant Signature and Date		 X________________________________
Co-Applicant Signature and Date

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.

PROOF OF INCOME REQUIRED FOR ALL LOANS

PLEASE FAX OR MAIL THE LAST TWO CURRENT PAY STUBS