Secure Loan Application
P.O. Box 323, Alloy, WV 25002
Phone: (304) 779-2773  •  Fax: (304) 779-2683
Account Number - If You Are A Member Amount Requested Type Of Loan Applying For Term
$ Months
Purpose/Collateral:
PRIMARY APPLICANT
  
JOINT APPLICANT

Name: First, Middle, Last

 Name: First, Middle, Last
Social Security Number:
 Date of Birth:
 
Social Security Number:
 Date of Birth:
What Is Your Email Address?
   What Is Your Email Address?
Home Phone Number:
 Cell Phone Number:
I Can Be Best Reached Via:
 
Home Phone Number:
 Cell Phone Number:
I Can Be Best Reached Via:
What Is Your Home Address?
Street: City:
  What Is Your Home Address?
Street: City:
State: Zip:
 
State: Zip:
Monthly Housing Payment or Rent: $   Monthly Housing Payment or Rent:  $
Number Of Dependents:   Number Of Dependents:
 
Current Employer:
 Business Phone:
Supervisor's Name:
Start Date: Hours at Work:
Gross Salary: $    
Hourly Salary: $  
Frequency:
Other Income: $
Frequency:
Source Of Income:
   
Previous Employer If Employed Less Than 4 Years:
Previous Employer Address:
City, State, Zip Code:
Start Date: End Date:
 
Current Employer:
 Business Phone:
Supervisor's Name:
Start Date: Hours at Work:
Gross Salary: $    
Hourly Salary: $
Frequency:
Other Income: $
Frequency:
Source Of Income:
   
Previous Employer If Employed Less Than 4 Years:
Previous Employer Address:
City, State, Zip Code:
Start Date: End Date:
REFERENCES
Nearest Relative (Not Spouse):   Personal:
 
Phone:   Phone:
Address:   Address:
OTHER INFORMATION
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
 
Would you like to purchase Single Credit Disability Insurance? Yes None
If application is for a vehicle loan, would you like to purchase Gap Insurance ? Yes None
 
Have You Filed For Bankruptcy? Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?

You agree that everything stated in this application is correct to the best of your knowledge. The Credit Union is authorized to investigate your creditworthiness, employment history, and to obtain a credit report to answer questions about their credit experience with you. You understand that any false or misleading statement in your application may cause any loan or extension of credit based upon such false or misleading statement to be decalared in default. You authorize us to accept your facsimile signatures on this application and agree that your facsimile signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature. Security on one loan is security on any monies owed to the Credit Union.

PLEASE MAIL, FAX, OR BRING INTO TO OUR OFFICE YOUR MOST RECENT PAY CHECK STUB.

By pressing the "Submit Application" button below, you agree to the above statement. You understand that we may require additional information to finalize our credit decision and your signature on additional documents prior to disbursing any credit proceeds.