Cooperative Employees Credit Union Secure Loan Application

Loan Type

*Loan Type

Purpose of Loan

Requested Amount ($)

Requested Term for Loan

I have read and agree with the Credit Card Terms and Conditions

Primary Applicant Information

*First Name

*Last Name

Account #

*Social Security #

U.S. Citizen

*Date of Birth

*Email Address

Number of Dependents

We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.

Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:

Marital Status

*Primary Phone

Secondary Phone

*Street Address

*City

*State

*Zip Code

Current Address since

Rent Own

Payment ($)

Enter Previous Address

Number of Months

Primary Applicant Employment Information

Applicant Employer's Name

Employer Phone #

Employer Address

Status

Position

Date Hired

Monthly Salary($)

Other Income/Month($)

Other Income Source

Previous Job Start Date

Previous Job End Date

Previous Employer's Name

NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.

Joint Applicant Information

Is there a joint applicant for this loan?

Yes

No

*First Name

*Last Name

Account #

*Social Security #

U.S. Citizen

*Date of Birth

*Email Address

Number of Dependents

We consider the primary borrower one dependent, a spouse would be the second dependent and then children would be subsequent dependents.

Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:

Marital Status

*Primary Phone

Secondary Phone

*Street Address

*City

*State

*Zip Code

Current Address since

Rent Own

Payment($)

Enter Previous Address

Number of months

Joint Applicant Employment Information

Applicant Employer's Name

Employer Phone #

Employer Address

Status

Position

Date Hired

Monthly Salary($)

Other Income/Month($)

Other Income Source

Previous Employer

Previous Job Start Date

Previous Job End Date

NOTE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for this credit request.

Applicant References

Nearest relative not living with you

First Name

Last Name

Suffix

Primary Phone

Home Address

City

State:

Zip Code

Relationship

Enter Additional Comments

Submit Application

READ CAREFULLY BEFORE SIGNING/SUBMITTING. PER YOUR MEMBERSHIP AGREEMENT AND /OR LOAN AGREEMENTS WITH THE COOPECU YOU GIVE US A SECURITY INTEREST IN YOUR ACCOUNT(S) AND CERTAIN OTHER PROPERTY PLEDGED AS DESCRIBED IN SAID AGREEMENTS.

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 768.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is 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 spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

You 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 what you owe. If there are any important changes you will notify us in writing immediately. 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. 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.

By submitting this application by facsimile or electronically, you agree to the same terms that apply to a signed application. If there is a co-applicant on this loan, the co-applicant has authorized the submission of this application. This facsimile or electronic submission qualifies as your signature. It is understood that you will have to sign loan documents before funds can be disbursed. And that proof of income must be submitted to the credit union before the application will be processed

By pressing the "Submit Application" button below, you agree to the above statement.