Loan Type *

Purpose *

Loan Term (in months) *

Repayment Method *

Applicant's name (First, M, Last) *

Social Security No. *

Driver's License No. *

Driver's License State *

Date of Birth *

Present Address *

Years There *

Previous Address (if less than 2 years at present address)

Years There

Phone (Best contact phone #) *

Email *

No. of Dependents *

Complete for joint credit, secured credit, or if you live in a community property state

Current Employer *

Position *

Hours worked per week *

Hourly rate *

Annual Income *

Employee Start Date *

Previous employer (if less than 2 years at present employer)

Start date

Other Income

Source

Residence *

Present Mortgage Co., Landlord, or Relative

Monthly Mortgage/Rent Payment

Current Value. If you own your home, what is the current value?

Mortgage Balance

Are you a citizen or permanent resident alien? *

Do you currently have any outstanding judgments or have 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? *

In your income likely to decline in the next two years? *

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)

Have you ever had a car or other personal property repossessed by a dealer or finance company, filed for bankruptcy, or been a party to a wage assignment or collection suit, or have you ever been declined on a loan application with this credit union? *

Name and address of nearest relative not living with you *

Relationship *

Phone *

Co-Applicant's name (First, M, Last) *

Social Security No. *

Driver's License No. *

Driver's License State *

Date of Birth *

Present Address *

Years There *

Previous Address (if less than 2 years at present address)

Years There

Phone (Best contact phone #) *

Email *

No. of Dependents *

Complete for joint credit, secured credit, or if you live in a community property state

Current Employer *

Position *

Hours worked per week *

Hourly rate *

Annual Income *

Employee Start Date *

Previous employer (if less than 2 years at present employer)

Start date

Other Income

Source

Residence

Present Mortgage Co., Landlord, or Relative *

Monthly Mortgage/Rent Payment (includes taxes and insurance) *

Current Value. If you own your home what is the current market value?

Mortgage Balance *

Are you a citizen or permanent resident alien? *

Do you currently have any outstanding judgments or have 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? *

In your income likely to decline in the next two years? *

Are you a co-maker, co-signer, or guarantor on any loan not listed above? *

Have you ever had a car or other personal property repossessed by a dealer or finance company, filed for bankruptcy, or been a party to a wage assignment or collection suit, or have you ever been declined on a loan application with this credit union? *

Name and address of nearest relative or friend not living with you *

Relationship *

Phone *