Lawrence Memorial Hospital Employee FCU Secure Loan Application

Loan Type

*Loan Type

Vehicle or Collateral information

*Amount Requested ($)

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 (NO PO Box):

*City

*State

*Zip Code

Current Address since

Rent/Own

Rent/Mortgage ($)

Enter Previous Address

Number of Months

Primary Applicant Employment Information

Applicant Employer's Name

Employer Phone #

Employer Address

Status

Position

Date Hired

Income $ (monthly)

Other Income/Month($)

Other Income Source

Previous Employer's Name

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.

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 (NO PO Box):

*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.

Payment Protection

Payment Protection* Preserve your financial future. Payment protection coverages provide a valuable safety net by making loan payments in the event of disability or death of a covered member. Your election of the coverages offered below is only a statement of intent. Payment protection options and enrollment will be finalized by the credit union.

Yes – Provide Term Life and Disability Coverage*

Yes – Provide Term Life only*

Yes – Provide GAP (Guaranteed Asset Protection)*

No – Not at this time*

* Not available for Home Equity loans.

Enter Additional Comments

Important Information About Procedures For Opening A New Account:

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Submit Application

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

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.

You promise that everything you have stated in this application is correct to the best of your knowledge. 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, 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 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 federally chartered credit unions insured by NCUA.

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