Secure Loan Application

Loan Information

Loan Type

Loan Purpose

Requested Amount ($)

Desired Length of Term:

I have read and agree with the Credit Card Terms and Conditions

Applicant Information

First Name

Last Name

Non-Member

Member #

Social Security #

Date of Birth

Marital Status

Email Address

Phone Number

Driver's License

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 3 yrs.

Street Address

City

State

Zip Code

From

To

Applicant's Employment Information

Applicant's Present Employer

Present Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Gross Monthly Income for the Employer Above

Whole Dollars. If you would like us to include other sources of income, please discuss this with our Loan Officers. Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Applicant's Previous Employer

Complete if current employment is less than 2 years.

Previous Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Employment End Date

Applicant's Other Income

Part-Time Income / 2nd Income per Month

Applicant Personal References

Please provide two references.

First and Last Name

Relationship To You

Phone Number

First and Last Name

Relationship To You

Phone Number

Is there a joint applicant?

No Yes

Joint Applicant Information

First Name

Last Name

Non-Member

Member #

Social Security #

Date of Birth

Marital Status

Email Address

Phone Number

Driver's License

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 3 yrs.

Street Address

City

State

Zip Code

From

To

Joint Applicant's Employment Information

Joint Applicant's Present Employer

Present Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Gross Monthly Income for the Employer Above

Whole Dollars. If you would like us to include other sources of income, please discuss this with our Loan Officers. Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Joint Applicant's Previous Employer

Complete if current employment is less than 2 years.

Previous Employer

Occupation

Street Address

City

State

Zip Code

Employer Phone #

Employment Start Date

Employment End Date

Joint Applicant's Other Income

Part-Time Income / 2nd Income per Month

Joint Applicant Personal References

Please provide two references.

First and Last Name

Relationship To You

Phone Number

First and Last Name

Relationship To You

Phone Number

How do you prefer to be contacted?

Phone Text Email

Comments

Enter Comments Here

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 and 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 force and 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 Form” button below, you agree to the above statement. You understand that we may require your signature on additional documents prior to disbursing any credit proceeds.

I have read this section and agree to the terms.