Single Applicant Loan Application

Step 1: Please choose your state of residence:


Loan Information
Indicates required field
 * Loan Amount: $
 * Purpose of Loan:
Method of Payment:
Protection that Matters
These are voluntary products.  Selecting these products will not influence your loan request.  Upon enrolling in these voluntary products, your loan office will provide more information, including product exclusions, limitations and benefits.
Optional: CREDIT LIFE INSURANCE
  Would you like to ensure that your eligible loan balance is reduced or paid off for your family if you unexpectedly die or become disabled due to injury or illness?
  YES       NO   
  * If checked yes, voluntary insurance may be elected by signing a separate form, which discusses the cost of insurance.  If I have attained age 65 or older, I am not eligible for credit insurance.
Primary Applicant Information
Complete the information below regarding the applicant(s).  Applicant and co-applicant information will be requested on separate pages.   Indicates required field.  
 * First Name: Drivers License Number:
 Middle Name: License State:
* Last Name: Work Phone Number:
Name Suffix: Work Phone Extension:
* Date of Birth: Home Phone Number:
Credit Union Account Number: Mobile Phone:
* Social Security Number:  * Email:
    Preferred Contact Method:
Primary Applicant - Address
Indicates required field
Complete the information below regarding the applicant(s).  Applicant and co-applicant information will be requested on separate pages.
 * Street Number: Housing / Residence Type:
 * Street Name: * Years & Months
at Address:
Years        
Months
Apt Number: * Mortgage Holder or Landlord Name:
* City: * Monthly Rent or Board:
* State / Province: * Mortgage Balance:
* ZIP / Postal Code: * Mortgage Payment:
Primary Applicant -
Previous Address if less than 2 years at current address:
Complete the information below regarding the applicant(s).  Applicant and co-applicant information will be requested on separate pages.   Indicates required field
Street Number: Housing / Residence Type:
Street Name: Years & Months at Address: Years
Months
Apt Number: Mortgage Holder or Landlord Name:
City: Monthly Rent or Board:
State / Province: Mortgage Balance:
ZIP / Postal Code: Mortgage Payment:
Primary Applicant - Employment
Complete the information below regarding the applicant(s).  Applicant and co-applicant information will be requested on separate pages.    Indicates required field
 Self Employed: Yes    No Years & Months at Job: Years        
Months
 Job Title: * Gross Salary (before taxes): $
* Name of Employer: * Pay Frequency:
Employer Address:    
Employer State/Province:    
Employer ZIP/Postal Code:    
Primary Applicant - Other Income / Other Employment
Complete the information below regarding the applicant(s).  Applicant and co-applicant information will be requested on separate pages.    Indicates required field
 Income Description:
Other Income Source:    
Other Income - Gross Monthly Amount:    
Income Frequency    
       
 Income Description:
Other Income Source:    
Other Income - Gross Monthly Amount:    
Income Frequency    
       
Primary Applicant - What You Owe
Use the fields below to list any outstanding debts such as auto loans, revolving charge accounts, real estate loans, etc. 
 Account Number:

Additional Debt Sources:

 Liability Type:  Account Number:  Account Number:
Loan Balance:  Liability Type:  Liability Type:
Monthly Payment: Loan Balance: Loan Balance:
Creditor Name: Monthly Payment: Monthly Payment:
    Creditor Name: Creditor Name:
Primary Applicant - What You Own
Use the fields below to list any property that you own including vehicles and real estate.
Home Automobile #1 Automobile #2
 Date Purchased: Year, Make Model: Year, Make Model:
 Purchase Price: Financed By: Financed By:
Current Market Value: Balance Owing: Balance Owing:
Home in whose name::
Monthly Payment: Monthly Payment:
Primary Applicant - References
 Type of Reference:
 Reference's Name:
Reference's Address City:
Reference Address:
Reference Address ZIP/Postal Code:
Day Phone:
Primary Applicant - Questions
 * Do you have any outstanding judgments? NO
YES
* Is your income likely to decline in the next two years? NO     YES
 * Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13? NO 
YES
* Are you a co-maker, co-signer or guarantor
on any loan not listed above?
NO     YES
* Have you had property foreclosed upon or
repossessed in the last 7 years?
NO
YES
* If yes, what is the monthly payment? NO     YES
* Are you a party in a law suit?
NO 
YES
* Are you liable for alimony, child support
or maintenance programs?
NO     YES
* Are you other than s U.S. Citizen
or permanent resident alien? 
NO     YES * If yes, what is the monthly payment?
You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You authorize the Credit Union to verify or have reverification of any information contained in the application at any time. You understand that the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on the loan applications made to federal credit unions or state chartered credit unions insured by NCUA. You understand that the use of your card will constitute acknowledgement of receipt and agreement to the terms of the credit card agreement. A condition of your account is granting us a security interest in your share accounts. By signing below you grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. Shares and deposits in any Individual Retirement Account and any other account that would lose special tax treatment under state or federal law if given as security are not subject to this security interest. When you are in default we may apply the balance in these accounts to any amounts due under the credit card agreement.
  I Disagree