APPLICATION FOR CREDIT
Fields marked with a "*" are REQUIRED fields

Date: 04-16-2014 Purpose of Loan: Account Number:

LOAN INFO:
Amount Requested:* Payable In:(Dollar Amount) Installments of:(Number of Months) each

PERSONAL INFO:
First Name:* Middle Initial:* Last Name:*
Birth Date: Month:* Day:* Year:* Enter month and day as two-digit number, no hyphens, no dashes, and four-digit year.
Residence Address Street:* Apt#
City:* State:* Zip:*
How long years:* Months:*
Phone No:* Social Security Number:* Number Of Dependents: Co-Applicants Name:

CURRENT EMPLOYER:
Employed By:* How Long (Years):* How Long (Months): Position:
Take Home Pay:* How Often:*
Address:* Phone at Work:*

PREVIOUS EMPLOYMENT:
Previous Employer: Address: Position: Years There: Monthly Income:

OTHER INCOME (do not include alimony, child support, maintenance payments or co-applicants income)
Source: Date Source Began: (Example: 12/01/2008) Amount Monthly: (Numbers Only)
Source: Date Source Began: (Example: 12/01/2008) Amount Monthly: (Numbers Only)

CHILD SUPPORT: You need not disclose the following sources of income ;but if you want the credit union to consider such income in connection with this loan application , please complete the following:
Child Support: (Monthly) Person Liable: Ages of Children: (Seperate with commas)
How long have child support payments been made? (Months) Are payments up to date? (Yes / No)

PLEASE INCLUDE DATA ABOUT CO-APPLICANT
IF APPLICATION IS FOR JOINT CREDIT WITH CO-APPLICANT, OR IF APPLICANT WILL RELY ON CO-APPLICANT'S INCOME


Co-Applicants Name: Birth Date (example:01/01/1970) Social Security Number
Address if different from yours: Telephone:
Co-Applicant's Employer How Long Employed:: Years: Months:
Co-Applicant's Employer Address Co-Applicant's Employer Phone:
Position or Title Take Home Salary: Pay Frequency Date of Pay Days:
Co-Applicants Other Source of Income Take Home Salary:

NEAREST RELATIVE NOT LIVING WITH YOU


Name:* Complete Address:* Phone Number:* Relationship:*

HOME
Own, buying or rent home:* Landlord or Mortgage Holder: Name in Which Titled:
Value: Balance:* Monthly Payment:*
Insurance Agent's Name: Address: Phone:

VEHICLES
Make of Auto:* Year:* Financed By: Name in Which Titled:
Value(Numbers Only):: Balance:* Monthly Payment:*

Make of Auto: Year: Financed By: Name in Which Titled:
Value(Numbers Only):: Balance: Monthly Payment:

Auto Insurance Agent's Name: Address: Phone:

STATEMENT OF TOTAL INDEBTEDNESS AND LIABILITIES FOR WHICH YOU ARE OBLIGATED IN ANY MANNER. USE BLANKS BELOW IF NECESSARY.


Name in Which Account Appears: Name of Creditor: Account No.:
Type (Mortgage, Auto, Credit Card, Etc..): Balance: Monthly Payments:

Name in Which Account Appears: Name of Creditor: Account No.:
Type (Mortgage, Auto, Credit Card, Etc..): Balance: Monthly Payments:

Name in Which Account Appears: Name of Creditor: Account No.:
Type (Mortgage, Auto, Credit Card, Etc..): Balance: Monthly Payments:

Name in Which Account Appears: Name of Creditor: Account No.:
Type (Mortgage, Auto, Credit Card, Etc..): Balance: Monthly Payments:

Name in Which Account Appears: Name of Creditor: Account No.:
Type (Mortgage, Auto, Credit Card, Etc..): Balance: Monthly Payments:

Name in Which Account Appears: Name of Creditor: Account No.:
Type (Mortgage, Auto, Credit Card, Etc..): Balance: Monthly Payments:

MISC


Best way to contact you (Fill in Phone Number or Email Address):
Are You a Co-signer on Any Other Loans:* Do you pay alimony, child support or maintenance payments:* How much:
Any legal proceedings against you:* (Yes / No) Have you ever filed for bankruptcy:* (Yes / No) When: Reason: