Apply for a Loan

Applicant Information

• First Name *
• Last Name *
• Date of Birth *
• Account Number
• Social Security Number *
• Driver's License Number
• Drivers License State
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Home Phone *
• Cell Phone
• Work Phone *
• Email
• Preferred Contact Method *
  Work Home Cell Email
• Address *
• Address
• City *
• State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip *
• Housing Type*
  Own Rent Live with parents
• Years and Months at address *
• Mortgage Holder or Landlord Name
• Monthly rent or board
• Mortgage Balance
• Mortgage Payment

If less than 2 years at current address:

• Previous Address
• Previous Address
• Previous City
• Previous State
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Previous Zip

Employment Information

• Self Employed *

  Yes No
• Job Title
• Employer Name *
• Employer Address *
• Employer City *
• Employer State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Employer Zip
• Years and months at job
• Gross salary per pay period
• Pay frequency*
  Monthly Bi-weekly Weekly Semi-monthly

If employed for less than 2 years at your current job:

• Previous Employer Name
• Previous Employer Address
• Previous Employer City
• Previous Employer State
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Previous Employer Zip
• Previous Years and months at job

Additional Income

• Additional Income
• Other Income Source
  Overtime Parttime Rental income Alimony Child Support Maintenance
• Additional Income Gross Monthly Amount
• Pay frequency
  Monthly Bi-weekly Weekly Semi-monthly

Joint Applicant Information

First Name *

Last Name *

Date of Birth *

Account Number

Social Security Number *

Driver's License Number

Drivers License State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Home Phone *

Cell Phone

Work Phone *

Email

Preferred Contact Method *

Work Home Cell Email

Address *

Address

City *

State *

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip *

Housing Type*

Own Rent Live with parents

Years and Months at address *

Mortgage Holder or Landlord Name

Monthly rent or board

Mortgage Balance

Mortgage Payment

If less than 2 years at current address:

Previous Address

Previous Address

Previous City

Previous State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Previous Zip

Employment Information

Self Employed *

Yes No

Job Title

Employer Name *

Employer Address *

Employer City *

Employer State *

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employer Zip *

Years and months at job

Gross salary per pay period

Pay frequency*

Monthly Bi-weekly Weekly Semi-monthly

If employed for less than 2 years at your current job:

Previous Employer Name

Previous Employer Address

Previous Employer City

Previous Employer State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Previous Employer Zip

Previous Years and months at job

Additional Income

Additional Income

Other Income Source

Overtime Parttime Rental income Alimony Child Support Maintenance

Additional Income Gross Monthly Amount

Pay frequency

Monthly Bi-weekly Weekly Semi-monthly

Debts

• Creditor Name
• Liability Type
• Account Number
• Loan Balance
• Monthly Payment

Additional Outstanding Debts

• Creditor Name
• Liability Type
• Account Number
• Loan Balance
• Monthly Payment

Property Owned

Home

• Date Purchased
• Purchase Price
• Current Market Value
• In whose name

Automobile 1

• Year, Make & Model
• Financed By
• Balance Owning
• Monthly Payment

Automobile 2

• Year, Make & Model
• Financed By
• Balance Owing
• Monthly Payment

References & Agreement

• Type of Reference *
• Reference Name *
• Reference Address *
• Reference Address
• Reference State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Reference Zip *
• Reference Phone *
• Do you have any outstanding judgments? *

  Yes No
• Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?*

  Yes No
• Have you had property foreclosed upon or repossessed in the last 7 years?*

  Yes No
• Are you other than a U.S. Citizen or permanent resident alien? *

  Yes No
• Is your income likely to decline in the next two years? *

  Yes No
• Are you a co-maker, co-signer or guarantor on any loan not listed above? *

  Yes No
• If yes, what is the monthly payment *
• Are you liable for alimony, child support or maintenance programs? *

  Yes No
• If yes, what is the monthly payment *

I/We agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Funds availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of a copy of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

• Primary Applicant Date *
• Joint Applicant Date *
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