* Required Fields Best Time to Call You: Best Phone # To Reach You: Collateral: Select... Vehicle Paid in Full CD Deposit Account Home Other None Purpose of Loan: Term: Select... 12 Months 24 Months 36 Months 48 Months 60 Months 72 Months 84 Months Other Account Number: Amount Requested: Down Payment/Trade-in/Cash: Credit Life Credit Disability Payroll Deduction *Application Type: Individual Joint Please Tell Us About Yourself (Primary Borrower) Full Name: Street Address: Street Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Years There: Home Value: Own Buying Renting Other Property Owned: Your Vehicles Vehicle #1 - Year: Vehicle #1 - Make: Vehicle #1 - Model: Vehicle #2 - Year: Vehicle #2 - Make: Vehicle #2 - Model: Have you ever filed Bankruptcy? Yes No Date, if yes: Are you a co-maker on other loans: Yes No If so, for whom? How much? Home Phone: Work Phone: Cell Phone: Social Security Number: Birth Date: Birth Date: Month Month... January February March April May June July August September October November December / Birth Date: Day Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Birth Date: Year Year... 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 Email Address: Please Tell Us About Your Job (Primary Borrower) Current Employer: Years There: Phone Number: Position: Gross Monthly Salary/Hourly Income: Monthly dollar amount that you receive in alimony, child support, or separate maintenance - this income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Other Income: Source: Statement of Total Indebtedness and Liabilities Mortgage/Rent Owed To: Security: Balanced Owed: Monthly Payment: Landlord's Address (if applicable): Landlord's Phone (if applicable): Auto Loan Owed To: Security: Balance Owed: Monthly Payment: Credit Union/Bank Owed To: Security: Balance Owed: Monthly Payment: Credit Card Owed To: Security: Balanced Owed: Monthly Payment: Other Owed To: Security: Balance Owed: Monthly Payment: Please List Nearest Relative Not Living With You Full Name: City: Home Address: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code: Primary Phone Number: The following information pertains to CO-BORROWER. Please Tell Us About Yourself (Co-Borrower) Co-borrower Signature: I intend to sign this document as a co-borrower Full Name: Street Address: Street Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Years There: Home Phone: Work Phone: Cell Phone: Social Security Number: Birth Date: Birth Date: Month Month... January February March April May June July August September October November December / Birth Date: Day Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Birth Date: Year Year... 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 Email Address: Your Vehicles Vehicle #1 - Year: Vehicle #2 - Make: Vehicle #1 - Make: Vehicle #1 - Model: Vehicle #2 - Year: Vehicle #2 - Model: Other Property Owned: Please Tell Us About Your Job (Co-Borrower) Current Employer: Years There: Phone Number: Position: Gross Monthly Salary/Hourly Income: Monthly dollar amount that you receive in alimony, child support, or separate maintenance - this income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Other Income: Source: Please List Nearest Relative Not Living With You Full Name: Home Address: Home Address: Address Second Line City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Primary Phone Number: Are you interested in having your loan protected? Yes No If you answer "yes", the credit union will disclose the cost to protect your loan. The protection is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a seperate application that explains the terms and conditions. Click the "I accept the terms of the disclaimer above and submit my application" selection to send the application to us via the WWW after reading the disclaimer below. By clicking "I accept the terms of the disclaimer above and submit my application", you accept the terms of the disclaimer below.DISCLAIMER: I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION. I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US.Federal law requires verification of valid identification on all new accounts. As a loan is included in the definition of a new account, please be prepared to show valid identification.A five dollar loan application fee may be assessed. 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