Loan Application
HOW TO APPLY	please complete red sections 1 through 8 sign section 9 return to credit union
1 NOTE AND COMPLETE	Married Applicants may apply for separate account. Check the appropriate box to indicate individual credit or Joint Credit. Individual Credit: Complete Applicant section. Complete co-Applicant, Spouse, guarantor (referred to as "Other") section: (1) about your spouse if you live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI), or (2) if your spouse will use the account, or (3) if there is a guarantor on this account. Please check box to indicate whom the information is about. Joint Credit: Provide information about both of you by completing Applicant and Other section Amount Requested $_________________ Purpose:_____________________________________ Collateral: Repayment: Payroll Deduction  Cash   Automatic Payment  Military Allotment  ______________
STATEMENT OF INTENT Check if desired	Credit disability 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. Single Credit Life Insurance Joint Credit Life Insurance
2 APPLICANT INFORMATION	NAME (last - first - Initial) DRIVER'S LICENSE NUMBER / STATE ACCOUNT NUMBER SOCIAL SECURITY NUMBER BIRTH DATE HOME PHONE BUSINESS PHONE / EXT. (     ) (     ) 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) LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT (Exclude Self) CO APPLICANT SPOUSE GUARANTOR Use "SAA" if Information is "Same As Applicant NAME (last - first - Initial) DRIVER'S LICENSE NUMBER / STATE ACCOUNT NUMBER SOCIAL SECURITY NUMBER BIRTH DATE HOME PHONE BUSINESS PHONE / EXT. (     ) (     ) 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) LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT (Exclude Self)
3 EMPLOYMENT INFORMATION         MILITARY         MILITARY	NAME AND ADDRESS OF EMPLOYER ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- YOUR TITLE/GRADE                                                    SUPERVISOR'S NAME START DATE                        HOURS AT WORK                        IF SELF EMPLOYED, TYPE OF BUSINESS IF EMPLOYED IN CURRENT POSITION LESS THAN FIVE YEARS. STARTING DATE __________________ ENDING DATE COMPLETE PREVIOUS EMPLOYER NAME AND ADDRESS ------------------------------------------------------ ------------------------------------------------------ IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR YES NO WHERE ENDING/SEPARATION DATE NAME AND ADDRESS OF EMPLOYER ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- YOUR TITLE/GRADE                                                    SUPERVISOR'S NAME START DATE                        HOURS AT WORK                        IF SELF EMPLOYED, TYPE OF BUSINESS IF EMPLOYED IN CURRENT POSITION LESS THAN FIVE YEARS. STARTING DATE __________________ ENDING DATE COMPLETE PREVIOUS EMPLOYER NAME AND ADDRESS ------------------------------------------------------ ------------------------------------------------------ IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR YES NO WHERE ENDING/SEPARATION DATE
4 APPLICANT INFORMATION Please Include Street, City, State and Zip	NAME AND ADDRESS OF CREDITOR(S) OF DEBTS PAID OFF                                    TELEPHONE ----------------------------------------------------------------------------- RELATIONSHIP __________________ HOME PHONE NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU ------------------------------------------------------ HOME PHONE NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU ------------------------------------------------------ NAME AND ADDRESS OF CREDITOR(S) OF DEBTS PAID OFF                                    TELEPHONE ----------------------------------------------------------------------------- RELATIONSHIP __________________ HOME PHONE NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU ------------------------------------------------------ HOME PHONE NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU ------------------------------------------------------
5 INCOME INFORMATION	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 EMPLOYMENT INCOME OTHER INCOME $ PER $ PER NET GROSS SOURCE
6 ASSETS Check box for applicant/Other. List all assets and account number(s) - Attach other sheets if necessary	SHAREDRAFT OR CHECKING AMOUNT NAME AND ADDRESS OF DEPOSITORY $_____________________________________________________________________________________ SAVINGS AMOUNT NAME AND ADDRESS OF DEPOSITORY $_____________________________________________________________________________________ SHAREDRAFT OR CHECKING AMOUNT NAME AND ADDRESS OF DEPOSITORY $_____________________________________________________________________________________ SAVINGS AMOUNT NAME AND ADDRESS OF DEPOSITORY $_____________________________________________________________________________________ APPLICANT     OTHER   List Home And All Other Items You Own And location Of Property For Example: auto, Boat, Stocks, Bonds, Cash, Household Goods, Real Estate, etc. Market Value Pledged as Collateral For another Loan     HOME   $   YES   NO         $    YES   NO         $   YES   NO
7 DEBTS In addition to Rent/Mortgage list all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance. IRS liabilities,etc.) Please use a separate line for each credit card and auto loan. attach other sheets if necessary	APPLICANT     OTHER   CREDITOR NAME AND ADDRESS ACCOUNT NUMBER ORIGINAL BALANCE PRESENT BALANCE MONTHLY PAYMENT PAST DUE     RENT MORTGAGE (Incl. Tax & ins.)      $ $ $             $ $ $             $ $ $             $ $ $             $ $ $             $ $ $             $ $ $   List any Names under Which Your Credit References And Credit History Can Be Checked TOTALS $ $ $
8 FINANCIAL INFORMATION These questions apply to both Applicant and Other.	APPLICANT OTHER IF A "YES" ANSWER IS GIVEN TO A QUESTION, EXPLAIN ON AN ATTACHED SHEET YES NO YES NO DO YOU HAVE ANY OUTSTANDING JUDGMENTS?         HAVE YOU EVER FILED FOR BANKRUPTCY OR HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13?         HAVE YOU HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS?         ARE YOU A PARTY IN A LAWSUIT?         ARE YOU OTHER THAN A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?         IS 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):
9 SIGNATURES	If there are any important changes,you will notify us in writing immediately. You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter. You also 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 all your debts and obligations. You authorize the credit union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. 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. You understand that 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____________________________________________________ OTHER SIGNATURE DATE APPLICANT'S SIGNATURE DATE
10 CREDIT UNION INFORMATION Do not write in this section - for credit union use only. Check applicable box(es).	_______ APPROVED LIMITS $___________ $_______________ $________ $________ $___________ DATE SIGNATURE LINE OF CREDIT OTHER OTHER DEBT RATIO LOAN OFFICER ADVANCE APPROVED:   YES     NO       COUNTER OFFER WILL BE MADE, IF ACCEPTED, ADVANCE APPROVED CREDIT COMMITTEE OR OTHER   OUTSIDE INFORMATION CONSIDERED: YES NO      IF, YES ATTACH ADDITIONAL SHEET AND DESCRIBE REFERRED TO/REASON(S) FOR REFERRAL:__________________________________________________________________ DESCRIBE COUNTER OFFER:_______________________________________________________________________________ SPECIFIC REASON(S) FOR REJECTION:______________________________________________________________________ SIGNATURES: LOAN OFFICER X___________________________ DATE____________    X___________________________ DATE____________ CREDIT COMMITTEE X___________________________ DATE____________    X___________________________ DATE____________ ECOA NOTICE AND REASON FOR REJECTION SENT AND DELIVERED ON:  _____________________ (DATE)   BY_______________________________      ________(INITIALS)
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