Secure Loan Application

Loan Type

Loan Purpose

Requested Amount ($)

Do You Want Credit Life?

Do You Want Credit Disability?

Method of Payment?

Payment Frequency?

Applicant Information

First Name

Last Name

Member #

Social Security #

Date of Birth

Email Address

Phone Number

Driver's License

Street Address

City

State

Zip Code

Years at This Address

Housing Status

Monthly Housing Expense

Previous Address

Years at This Address

Employment Information

Present Employer

Occupation

Employer Phone #

Years There

Gross Monthly Income for the Employer Above

Previous Employer

Occupation

Employer Phone #

Years There

References

Please provide two references that don't live with you.

First and Last Name

Relationship To You

Phone #

First and Last Name

Relationship To You

Phone #

Is there a joint applicant?

No Yes

Joint Applicant Information

First Name

Last Name

Member #

Social Security #

Date of Birth

Email Address

Phone Number

Driver's License

Street Address

City

State

Zip Code

Years at This Address

Housing Status

Monthly Housing Expense

Previous Address

Years at This Address

Joint – Employment Information

Present Employer

Occupation

Employer Phone #

Years There

Gross Monthly Income for the Employer Above

Previous Employer

Occupation

Employer Phone #

Years There

Joint – Personal References

Please provide two references that don't live with you.

First and Last Name

Relationship To You

Phone #

First and Last Name

Relationship To You

Phone #

Comments

Enter Comments Here

By signing below, I certify that the information on both sides of this application and on any attachments, both written or printed is true and correct and represents my current financial condition accurately, and that I have no other debts than those stated. If there are important changes, I will notify you in writing immediately. I understand that any false statements or willful over-evaluation of land, property or security for the purpose of influencing in any way the action of any insured credit union upon any loan application is a violation of Section 1014, Title 18, U.S. Code.
The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy 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.
I authorize you to gather whatever credit and employment information you consider necessary and appropriate. I authorize you to give information concerning your credit experience with me to others. I understand that you will retain this application whether or not credit is approved. If this application is signed by more than one person, the words “I” and “my” shall mean all those who sign the application.

I have read this section and agree to the terms.

Loan Application

Applicant Information

Employment Information

References

Please provide two references that don't live with you.

Joint Applicant Information

Joint – Employment Information

Joint – Personal References

Please provide two references that don't live with you.

Comments

The Florist FCU Application and Solicitation Disclosure for VISA Platinum and VISA Secured

The Florist FCU
Application and Solicitation Disclosure
for VISA Platinum and VISA Secured