Loan Application

Married Applicants: May apply for a separate account.
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI),
your spouse will use the account, or
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 Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.

LOANLINER Account/Loan

(Including ATM/Debit Card Access to the Account if Available)

Amount Requested $

Purpose/Collateral

Repayment

PAYMENT PROTECTION

Are you interested in having your loan protected? If you answer "yes", the credit union will disclose the cost to protect your loan. The protection is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.

APPLICANT

Name

First Name

Last Name

Account Number

Social Security Number

Drivers License Number/State

Ages of Dependents

Email Address

Birth Date

YYYY

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Present Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Own/Rent?

Length at Residence

Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Own/Rent?

Length at Residence

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:

EMPLOYMENT/INCOME

Name and Address of Employer

Title/Grade

Start Date

Hours at Work

Supervisor's Name

If Self Employed, Type of Business

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

Employment Income $

Per

Other Income $

Per

Source

MILITARY

IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?

Where

Ending/Separation Date

PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS

Starting Date

Ending Date

REFERENCE

NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU

Relationship

Home Phone

(###)

###

####

OTHER

Select

Name

First Name

Last Name

Account Number

Social Security Number

Drivers License Number/State

Ages of Dependents

Email Address

Birth Date

YYYY

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Present Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Own/Rent?

Length at Residence

Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Own/Rent?

Length at Residence

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:

EMPLOYMENT/INCOME

Name and Address of Employer

Title/Grade

Start Date

Hours at Work

Supervisor's Name

If Self Employed, Type of Business

NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.

Employment Income $

Per

Other Income $

Per

Source

MILITARY

IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?

Where

Separation/Ending Date

PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS

Starting Date

Ending Date

REFERENCE

NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU

Relationship

Home Phone

(###)

###

####

WHAT YOU OWE

CREDITOR NAME OTHER THAN THIS CREDIT UNION (One per line)

INTEREST RATE (One per line)

PRESENT BALANCE (One per line)

MONTHLY PAYMENT (One per line)

OWED BY APPLICANT OR OTHER (One per line)

LIST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED

WHAT YOU OWN

LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION (One per line)

MARKET VALUE $ (One per line)

PLEDGED AS COLLATERAL FOR ANOTHER LOAN YES/NO (One per line)

OWNED BY APPLICANT OR OTHER (One per line)

OTHER INFORMATION ABOUT YOU

1. ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?

2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT?

3. IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?

4. ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE?

FOR WHOM (Name of Others Obligated on Loan)

TO WHOM (Name of Creditor)

IF YOU ANSWER "YES" TO ANY QUESTION OTHER THAN #1, EXPLAIN

STATE LAW NOTICES

OHIO RESIDENTS ONLY: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

SIGNATURES

You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. 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 understand that the Credit Union will rely on the information in this application and your credit report to make its decision. 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. It is a crime to willfully and deliberately provide incomplete or incorrect information in this application.

Applicant's Signature

Other Signature

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Loan Application

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