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LOAN APPLICATION
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:
1. 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),
2. your spouse will use the account, or
3. 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: If you are applying with another person, complete the Applicant and Other sections.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Check below to indicate the type of account(s) and type of credit for which you are applying. Married applications may apply for a separate account
   
LOANLINER Account/Loan:    
   
Individual  
   
Joint   Amount Requested $____________   Purpose/Collateral:_____________________
(Including ATM/Debit Card access to the account if Available)
Repayment:
   
Payroll Deduction 
   
Cash  
   
Military Allotment 
   
Automatic Payment 
   
Other ______________
Payment Protection
   
Single Credit Disability Insurance 
   
Single Credit Life Insurance 
   
Joint Credit Life Insurance 
Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
Applicant
  Other:      
   
  Co-Applicant    
   
  Spouse  
 NAME (last - first - Initial)  MOTHER'S MAIDEN NAME
 ACCOUNT NUMBER  SOCIAL SECURITY NUMBER
 DRIVER'S LICENSE NUMBER / STATE LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT (Exclude Self)    
BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.
  (     ) (     )
E-MAIL ADDRESS
PRESENT ADDRESS (Street - City - State - Zip)
   
OWN  
   
RENT  
 
YEARS
AT THIS
ADDRESS 
PREVIOUS ADDRESS (Street - City - State - Zip)
   
OWN  
   
RENT  
 
YEARS
AT THIS
ADDRESS 
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
   
MARRIED
   
SEPARATED
   
UNMARRIED (Single - Divorced - Widowed)
MORTGAGE/RENT OWED TO:
      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 OTHER INCOME
$_______________ PER_______________ $_______________ PER_______________
   
NET
   
GROSS
  SOURCE______________________________
MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?
   
YES 
   
NO 
WHERE ENDING/SEPARATION DATE
PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS

STARTING DATE
________________
ENDING DATE


Other
   
 Co-Applicant
   
 Spouse
   
 Guarantor
 NAME (last - first - Initial)  MOTHER'S MAIDEN NAME
 ACCOUNT NUMBER  SOCIAL SECURITY NUMBER
 DRIVER'S LICENSE NUMBER / STATE LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT (Exclude Self)    
BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.
  (     ) (     )
E-MAIL ADDRESS
PRESENT ADDRESS (Street - City - State - Zip)
   
OWN  
   
RENT  
 
YEARS
AT THIS
ADDRESS 
PREVIOUS ADDRESS (Street - City - State - Zip)
   
OWN  
   
RENT  
 
YEARS
AT THIS
ADDRESS 
COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
   
MARRIED
   
SEPARATED
   
UNMARRIED (Single - Divorced - Widowed)
MORTGAGE/RENT OWED TO:
      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 OTHER INCOME
$_______________ PER_______________ $_______________ PER_______________
   
NET
   
GROSS
  SOURCE______________________________
MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?
   
YES 
   
NO 
WHERE ENDING/SEPARATION DATE
PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS

STARTING DATE
_________________
ENDING DATE

Applicant Reference
NAME AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU

RELATIONSHIP

_______________
HOME PHONE

Other Reference
NAME AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU

RELATIONSHIP

_______________
HOME PHONE

What You Owe

CREDITOR NAME OTHER THAN THIS CREDIT UNION
(Attach additional sheet(s) if necessary)

INTEREST
RATE
PRESENT
BALANCE
MONTHLY
PAYMENT
OWED BY
Applicant Other
__Rent__1st Mortgage
(Include Tax & Ins.)
    $ $    
2nd Mortgages     $ $    
1st Auto Loan     $ $    
2nd Auto Lone     $ $    
Child-Care     $ $    
Child Support     $ $    
Credit Card     $ $    
Credit Card     $ $    
Other     $ $    
Other     $ $    
List any names under which your credit references and credit history can be checked: TOTALS $ $    
 
What You Owe

LIST LOCATION OF PROPERTY OR
FINANCIAL INSTITUTION

MARKET VALUE PLEDGED AS COLLATERAL
FOR ANOTHER LOAN
OWED BY
Applicant Other
HOME   $      YES      NO    
AUTO   $      YES      NO    
SAVINGS   $      YES      NO    
CHECKING   $      YES      NO    
OTHER (DESCRIBE)   $      YES      NO    
Other Information About You

IF YOU ANSWER "YES" TO ANY QUESTION OTHER THAN #1,
EXPLAIN ON AN ATTACHED SHEET

APPLICANT OTHER
YES NO YES NO
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 COFIRMED 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 DICLINE 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):
       
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 766.70, or court decree under 766.70 will adversely affect the rights of the Credit Union unless the Credit Unions 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.

X_______________________________________________________________________________
SIGNATURE FOR WISCONSIN RESIDENTS ONLY                               Date

Signatures
1.  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 use in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and any update, increase, renewal or extension 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 federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.
X __________________________________________ X __________________________________________
  Applicants Signature                                 Date   Other Signature                                 Date
For Credit Union Use Only
DATE     
   
APPROVED

APPROVED

SIGNATURE LINE OF CREDIT OTHER OTHER DEBT RATIO/SCORE
 
   
DENIED
(Adverse Action Notice Sent)
LIMITS: $ $ $ $ BEFORE      AFTER
LOAN OFFICER COMMENTS:  
Signature:
X_______________________________________
                                                                     Date
Signature:
X_______________________________________
                                                                     Date

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