Online Loan Application
ONLINE LOAN APPLICATION
How To Apply
Please fill out this application completely
Press the submit button at the end of the application
An incomplete application may delay processing
Individual Credit
You must complete the
Applicant
section about yourself and the
Other
section about your spouse, if
you live in or the property pledged as collateral is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI) or
you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the
Other
section to the extent possible about the person on whose payments you are relying.
Joint Credit
If you are applying with another person, complete the
Applicant
and
Other
sections.
Guarantor
Complete the
Other
section if you are a guarantor on the loan.
Check below to indicate the type of credit for which you are applying.
Married applicants may apply for separate accounts.
Loan:
Individual
Joint
Amount Requested $
Purpose/Collateral
Repayment
Payroll Deduction
Cash
Military Allotment
Automatic Payment
Payment
Protection
None
Single Credit Disability Insurance
Single Credit Life Insurance
Joint Credit Life Insurance
Check coverage desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
Applicant:
Name
First Name
MI
Last Name
Account Number
Social Security Number
000-00-0000
Driver's License
Number
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
List ages of dependents not listed by other applicant
(Exclude Self)
Home Phone
000-000-0000
Business Phone
000-000-0000
Birth Date
/
/
mm
dd
yyyy
Present Address
Street
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Own
Rent
Years at this Address
Previous Address
Street
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Own
Rent
Years at this Address
Complete for Joint Credit or if you live in a community property state:
Married
Separated
Unmarried
If Single, Divorced, or Widowed, select UNMARRIED
Applicant:
Employment / Income
Name of Employer
Address of Employer
Title/Grade
Start Date
mm/dd/yyyy
Work hours per week
Supervisor's Name
If self employed, type of business
Notice:
Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income
per
per
Net
Gross
Source
Military:
Is duty station transfer expected
during the next year?
Yes
No
Where to
Ending/Separation Date
mm/dd/yyyy
Previous employer name and address
if employed less than five years
Starting Date
mm/dd/yyyy
Ending Date
mm/dd/yyyy
Applicant:
Reference
Name and address of nearest relative not living with you
Relationship
Home Phone
000-000-0000
Other:
None
Co-Applicant
Spouse
Guarantor
Name
First Name
MI
Last Name
Account Number
Social Security Number
000-00-0000
Driver's License
Number
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
List ages of dependents not listed by other applicant
(Exclude Self)
Home Phone
000-000-0000
Business Phone
000-000-0000
Birth Date
/
/
mm
dd
yyyy
Present Address
Street
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Own
Rent
Years at this Address
Previous Address
Street
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Own
Rent
Years at this Address
Complete for Joint Credit or if you live in a community property state:
Married
Separated
Unmarried
If Single, Divorced, or Widowed, select UNMARRIED
Other:
Employment / Income
Name of Employer
Address of Employer
Title/Grade
Start Date
mm/dd/yyyy
Work hours per week
Supervisor's Name
If self employed, type of business
Notice:
Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income
per
per
Net
Gross
Source
Military:
Is duty station transfer expected
during the next year?
Yes
No
Where to
Ending/Separation Date
mm/dd/yyyy
Previous employer name and address
if employed less than five years
Starting Date
mm/dd/yyyy
Ending Date
mm/dd/yyyy
Other:
Reference
Name and address of nearest relative not living with you
Relationship
Home Phone
000-000-0000
What You Owe
Creditor name other than this credit union
Interest Rate
Present Balance
Monthly Payment
Owed by
Applicant
Other
Rent or
1st Mortgage
(include tax and insurance.)
2
nd
Mortgage
1
st
Auto Loan
2
nd
Auto Loan
Child Support
Credit Card
Credit Card 2
Other
Other 2
Totals
What You Own
List location of property or financial institution.
Market Value
Pledged as collateral for another loan.
Owned by
Yes
No
Applicant
Other
Home
Auto
Savings
Checking
Other (Describe)
Other Information
About You
If you answer "Yes" to any question other than #1, please explain in the text box below.
Applicant
Other
YES
NO
YES
NO
1. Are you a U.S. citizen or permanent resident alien?
2. Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?
3. Is your income likely to decline in the next two years?
4. Are you a co-maker, co-signer or guarantor on any loan not listed above?
For Whom
(Name of Others Obligated on Loan)
To Whom
(Name of Creditor)
Explanation
Signatures
By submitting this application, you promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. 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, renewal or extension 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 federal credit unions or state chartered credit unions insured by NCUA.
_____________________________
Applicant
____________________________
Date
______________________________
Co-Applicant/Spouse/Guarantor
_____________________________
Date
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