1814 E. Brooks Rd., Memphis, Tennessee 38116
Phone: (901) 396-2132 • Fax: (901) 345-0400
Secure Loan Application

Note: All fields with an asterisk (*) indicate required fields that must be completed before submitting your application.
 
LOAN INFORMATION
Enter Member #:
Is this your first loan from us? Yes No
Amount/Credit Limit Requested:
 $
Approximate Time to Repay:
 How Many Payroll Deduction:
Loan Type:
Purpose of loan:
Security Offered: (for secured credit only)
Marital Status:
If Married, does your spouse work? Yes No
Age of Dependents (seperate by commas):
Are you submitting individually or jointly?:
PRIMARY APPLICANT INFORMATION
First Name:
Middle Initial:
Last Name:
Date of Birth:
Social Security Number:
Drivers License or ID #:
Drivers License State:
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Email Address:
Street Address:
City:
State: Zip:
Time At Current Address:
 Years    Months
Type Of Housing:
       Monthly Housing Costs: $
Employer:
Job Title:
Time On Job:
 Years    Months
Time On Previous Job:
 Years    Months
Gross Income:
Source
 Monthly Income
$ 		Hourly Income
$
Source
 Monthly Income
$ 		Hourly Income
$
Source
 Monthly Income
$ 		Hourly Income
$
Monthly Childcare/Support Payment:
 $
Reference (Relative Not  Living With You):
First Name: MI: Last Name:
Address:
City:
State: Zip:
Phone:
Relationship:
Reference (Not A Relative):
First Name: MI: Last Name:
Address:
City:
State: Zip:
Phone:
Relationship:
Complete the following information
if your request is for a vehicle:
  
Type:
 N/A Purchase Vehicle Refinance Vehicle
Year Of Vehicle:
Make:
Model:
Vehicle Mileage:
Purchase Price:
 $
Down Payment:
 $
Current Payment On Trade In:
 $
 
Please Verify Employment by Faxing (901-345-0400) or e-mailing Last 2 Check Stubs and W2.
   
CO- APPLICANT INFORMATION
First Name:
Middle Initial:
Last Name:
Date of Birth:
Social Security Number:
Drivers License or ID #:
Drivers License State:
Home Phone Number:
Work Phone Number:
Email Address:
Street Address:
City:
State: Zip:
Time At Current Address:
 Years    Months
Type Of Housing:
       Monthly Housing Costs: $
Employer:
Job Title:
Time On Job:
 Years    Months
Time On Previous Job:
 Years    Months
Gross Income:
Source
 Monthly Income
$
Source
 Monthly Income
$
Source
 Monthly Income
$
Additional Notes:
I am interested in Credit Life and/or Disability Insurance on the loan. Yes No
Primary Applicant, Please Tell Us About Your Debts:
Lender
Type
Balance
Min. Pmt.
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00

Co-Applicant, Please Tell Us About Your Debts:
Lender
Type
Balance
Min. Pmt.
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00

OTHER INFORMATION
Are You A U.S. Citizen Or Permanent Resident Alien? Yes No
Have You Filed For Bankruptcy? Yes No
Are You  A Co-Maker/Endorser On Any Loan? Yes No
If Yes, Then For Whom? Balance: $ .00
Do You Currently Have Any Outstanding Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit? Yes No

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 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 forceand 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 additional information to finalize our credit decision and your signature on additional documents prior to disbursing any credit proceeds.