Secure Loan Application

Type of Loan Applying For

Select Loan Type From List

If other, enter type of Loan

Purpose of Loan/Collateral

Requested Amount ($)

Requested Term for Loan (in months)

I have read and agree with the

Applicant Information

First Name

Last Name

Account #

Social Security #

U.S. Citizen

Date of Birth

Email Address

Age of 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

Monthly Payment ($)

If less than 3 years:

Enter Previous Address

Number of months at previous address:

Number of Months

Joint Applicant Information

Is there a joint applicant for this loan?

Yes

No (If no, please continue to next page)

First Name

Last Name

Account #

Social Security #

U.S. Citizen

Date of Birth

Email Address

Age of 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

Monthly Payment($)

If less than 3 years:

Enter Previous Address

Number of months at previous address:

Number of months

Employment Information

Applicant Employer's Name

Employer Phone #

Employer Address

Status

Job Title

Date Hired

Employment Income($)

Frequency (Weekly,Bi-Weekly, Monthly, etc.)

Other Income/Month ($)

Other Income Source

Previous Employer's Name(if employed less than five years)

Number of Years with Previous Employer

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 Employment Information

No Joint Applicant Selected.

References

Nearest Relative not living with you

First Name

Last Name

Suffix

Primary Phone

Home Address

City

State:

Zip Code

Relationship

Comments

Enter Additional Comments

Submit Application

By submitting this application, you promise that everything you have stated in this application is correct to the best of your knowledge. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report in making its decision. You further understand that we may require additional information and/or documentation to finalize our credit decision. If you request, the Credit Union will provide you the name and address of any credit bureau from which it received a credit report on you. It is a crime to willfully and deliberately provide incomplete or incorrect information in this application.

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.

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

Type of Loan Applying For

Applicant Information

Joint Applicant Information

Employment Information

Joint Applicant Employment Information

References

Nearest Relative not living with you

Comments

Submit Application

Employees Choice FCU Application and Solicitation Disclosure for VISA Credit Card

Employees Choice FCU
Application and Solicitation Disclosure
for VISA Credit Card