Secure Loan Application

General Information

Loan Type *

Purpose of Loan *

Requested Amount ($) *

Desired Loan Date

Loan Term (In Months) *

Payment Source *

Applicant Information

First Name *

Middle Name

Last Name *

Member #

SSN *

Date of Birth *

Marital Status

Mother's Maiden Name

Driver's License Number *

Driver's License State *

Contact Information

Email Address *

Home Phone *

Work Phone

Cell Phone

Applicant's Present Address

Street Address *

City *

State *

Zip Code *

Years at this address *

Housing Status *

Monthly Housing Expense *

Applicant's Previous Address

Complete if present address is less than 2 yrs.

Street Address

City

State

Zip Code

From

To

Applicant's Employment Information

Applicant's Present Employer

Present Employer *

Occupation *

Employment Status *

Street Address *

City *

State *

Zip Code *

Employer Phone #

Employment Start Date *

Gross Monthly Income *

Applicant's Previous Employer

Complete if current employment is less than 2 years.

Previous Employer

Occupation

Employment Status

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Employment End Date

Applicant's Other Income

Monthly Income From Other Source

Source

Expenses

Child Support Payment

Mortgage/Rent Payment

Mortgage Balance

Primary Applicant Reference

Should be a family member or friend that is outside of the household

Full Name *

Relation *

Home Address (Street, City, State Zip)*

Phone Number *

Is there a joint applicant?

No Yes

Joint Applicant Information

First Name *

Middle Name

Last Name *

Member #

SSN *

Date of Birth *

Marital Status

Mother's Maiden Name

Driver's License Number *

Driver's License State *

Joint Applicant Contact Information

Email Address *

Home Phone *

Work Phone

Cell Phone

Joint Applicant's Present Address

Street Address *

City *

State *

Zip Code *

Years at this address *

Housing Status *

Monthly Housing Expense *

Joint Applicant's Previous Address

Complete if present address is less than 2 yrs.

Street Address

City

State

Zip Code

From

To

Joint Applicant's Employment Information

Joint Applicant's Present Employer

Present Employer *

Occupation *

Employment Status *

Street Address *

City *

State *

Zip Code *

Employer Phone #

Employment Start Date *

Gross Monthly Income *

Joint Applicant's Previous Employer

Complete if current employment is less than 2 years.

Previous Employer

Occupation

Employment Status

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Employment End Date

Joint Applicant's Other Income

Monthly Income From Other Source

Source

Joint Applicant's Expenses

Child Support Payment

Mortgage/Rent Payment

Mortgage Balance

Joint Applicant's Reference

Should be a family member or friend that is outside of the household

Full Name *

Relation *

Home Address (Street, City, State Zip)*

Phone Number *

Comments

Enter Comments Here

Individual Credit:

You must complete the applicant section about yourself and the other section about your spouse if:

You live in a community property state (AK, AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI) or
Your Spouse will use the account, or you are relying on your spouse's income as a source of repayment.

Joint Credit:

If you are applying for a joint account or an account that you and another person will use, you must:

Complete the applicant and other section.
You intend to apply for joint credit.

STATE NOTICES

OHIO RESIDENTS ONLY: The Ohio laws against discrimination requires 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.

WISCONSIN RESIDENTS ONLY: For any provision of any marital property agreement, court decree order section 766.70, or statement under section 766.59 to adversely affect the rights of the Credit Union, the Credit Union must be provided with a copy of the Agreement, decree or statement or have knowledge of its terms before any credit is approved or account opened. Sign if you are NOT applying for this loan account with your spouse. This credit request, if approved, will be incurred in the interest of the marriage or family of the undersigned.

DISCLOSURE

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 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 and other identifying information.

By continuing you agree that everything stated in this application is true and correct to the best of your knowledge, and that you agree to all terms in this disclosure. The Credit Union or its agent is authorized to investigate your credit worthiness, employment history, and to obtain a credit report and to answer questions about its credit history with you. The Credit Union may also obtain credit reports to update, increase, extend or renew credit with you. You hereby authorize Penlanco FCU to use the credit report(s) obtained from this application to make recommendations about other products, services, or loans that they believe would benefit you. False or misleading statements in your application may cause any loan to be in default. You agree that this application shall be the Credit Union's property whether or not this application is approved. You will notify the Credit Union in writing immediately of any changes in your name, address or employment. You understand that it is a crime to willfully and deliberately provide incomplete or incorrect information to obtain credit. If you request, you will be provided the name and address of any credit bureau from which we received a credit report.

As security for any loan advance to you or on your behalf, you grant the Credit Union a Security Interest in all individual and joint share or other accounts you have with the Credit Union now and in the future. When you are in default you authorize the Credit Union to take that money and apply it to what you owe. Shares and deposits that would have an adverse tax consequence if pledged as security are not subject to this Security Interest.

I have read this section and agree to the terms.