link to Electel home page

Secure Loan Request Form

3400 Sumner Boulevard
Raleigh, NC 27616
Phone: 919-872-2395 | Fax: 919-876-8018


Member Number: If not an ElecTel member, just leave blank.

Type Of Loan Applying For

New Auto Loan
Used Auto Loan
Recreational Vehicle (Boat, Camper, ATV, Motorcyle)

For Home Equity Loans, please contact us.

 Personal Loan
Shared Secured
Overdraft LOC
Energy Efficient Loan
Requested Amount: $ .00       Months
Repayment Option: Payroll Deduction     Automatic Payment     Coupon Book    

Debt Protection Coverage
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Single Life Coverage
Joint Life Coverage
 Single Credit Disability
Joint Credit Disability
 GAP
None

Applicant Information
Applicant's Name:
Social Security #:
Birthdate:
Driver's License #:
Driver's License State:
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:
Home Phone #:
Mobile Phone #:
Email Address:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
Own Rent
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Social Security #:
Birthdate:
Driver's License #:
Driver's License State:
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:
Home Phone #:
Mobile Phone #:
Email Address:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
Own Rent
If less than 3 yrs enter previous address:

Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address :
Position:
Supervisor:
Hours Worked:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address :
Position:
Supervisor:
Hours Worked:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
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
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?
   Is your income likely to decline in the next two years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?
Are you a U.S. citizen or permanent resident alien?

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

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

 
Comments
  

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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 and 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.

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