Loan Request Application

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Loan Information
Credit Type
Type of loan requested
Amount Requested
Loan Purpose
Collateral Offered	(if applicable)
Year
Make
Model
Length of Loan	(months or years)

Primary Applicant
Member Number	(leave blank if not a member)
Last Name	First Name MI
Social Security #
Date of Birth	mm/dd/yyyy
No. of Dependents
Address
City	State Zip
Home Phone
Cell Phone
E-Mail Address
Employer Name
Employer Address	(City,ST,Zip)
Employer Phone
Job Start Date	Month/Year
Gross Income	Annual
	Alimony, child support, or separate maintenance income need not be listed unless you choose to have such income considered regarding extension and repayment of the credit requested.
Job Title

Co-Applicant (if applicable)
Member Number	(leave blank if not a member)
Last Name	First Name MI
Social Security #
Date of Birth	mm/dd/yyyy
Address
City	State Zip
Home Phone
Cell Phone
E-Mail Address
Employer Name
Employer Address	(City,ST,Zip)
Employer Phone
Job Start Date	Month/Year
Gross Income	Annual
	Alimony, child support, or separate maintenance income need not be listed unless you choose to have such income considered regarding extension and repayment of the credit requested.
Job Title

Liabilities
Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment Description Monthly Payment

Agreement
In addition to Rent/Mortgage, list all other debts (for example, auto loans, credit cards, second mortgage, home association dues, alimony, child support, child care, medical utilities, auto insurance, IRS liabilities, etc.). Please use a separate line for each credit card and auto loan. Please note: Income verification is required; other information may be required. Acceptance maybe subject to verification of identity. Alimony, child support, or separate maintenance income need not be listed unless you choose to have such income considered regarding extension and repayment of the credit requested. 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. Your loan request will be reviewed as quickly as possible. A loan officer will contact you shortly. By submitting this loan request, you agree that the information is correct to the best of your knowledge and to all terms defined in the disclosure information above. You also agree to notify us of any changes to your name, address or employment.

Agreement

In addition to Rent/Mortgage, list all other debts (for example, auto loans, credit cards, second mortgage, home association dues, alimony, child support, child care, medical utilities, auto insurance, IRS liabilities, etc.). Please use a separate line for each credit card and auto loan.

Please note: Income verification is required; other information may be required. Acceptance maybe subject to verification of identity.

Alimony, child support, or separate maintenance income need not be listed unless you choose to have such income considered regarding extension and repayment of the credit requested.

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.

Your loan request will be reviewed as quickly as possible. A loan officer will contact you shortly.

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