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Secure Loan Application Form

1008 Veterans Memorial Pkwy, Tuscaloosa, AL 35404
Phone: (205) 759-7317 | Fax: (205) 758-5574
   
Type Of Loan Applying For

Type:

Amount Requested: $ .00      

Term: Months      



Payment Protection Coverage

Are you interested in having your loan protected with Credit Insurance?

Yes       No

*If you answer “yes”, the credit union will disclose the cost to protect your loan. The Credit Insurance is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.


Applicant Information
Applicant's Name:
Account # (if a member):
Social Security #:
Email:
US Citizen: Yes No
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Monthly House Payment: $ .00
Joint Applicant's Name:
Account #:
Social Security #:
Email:
US Citizen: Yes No
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Monthly House Payment: $ .00


Employment Information
Applicant Employer's Name:
Employer Phone #:
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:
Joint App. Employer's Name:
Employer Phone #:
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:
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.


Debts & Assets
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Assets:
Description: Value:
    
Description: Value:
    
Have you ever filed for bankruptcy or had debt adjustment under Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesion in the last 7 years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   Balance:


References (Nearest relative not living with you)
First Name: Middle Name: Last Name:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


 
References
First Name: Middle Name: Last Name:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


Contact Method
  How would you prefer to be contacted? Home Phone Cell Phone Email
 
  Additional Comments:


Submit Application

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 to be 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.