Applicant Information |
Account Number (Existing Member) |
|
*Amount Requested |
|
*Purpose of Loan |
Collateral Offered
|
*First Name |
*Middle
*Last Name |
*Date of Birth (MM/DD/YYYY) |
*Social Security
|
*Driver's License Number |
*State
|
Number of Dependents |
List Ages of Dependents
|
E-mail Address |
|
Present Home Address |
*Address Line 1 |
Line 2
|
*City |
*State
*Zip
|
*Own or Rent |
Own
Rent
Live w/Family |
*Monthly Mortgage/Rent Amount |
*Years There
|
*Home Phone Number |
(
)
*Cell (
)
|
Employment Information |
*Employer Name |
*Monthly Gross Income
|
*Start Date (MM/DD/YYYY) |
Work Phone Number (
)
|
Previous Employer (If current employment less than 2 years) |
|
Additional Income |
Additional Income Type |
|
Additional Amount |
Frequency
|
|
Deposits at other Financial Institutions (If none please put "none" in the first box) |
*Financial Institution Name |
Account #
Checking
Savings
|
Financial Institution Name |
Account #
Checking
Savings |
Financial Institution Name |
Account #
Checking
Savings |
Financial Institution Name |
Account #
Checking
Savings |
Clear Title Assets (Car/Property) (If none please put "none" in the first box) |
*Asset |
Value
Currently Pledged as Collateral:
Yes
No |
Asset |
Value
Currently Pledged as Collateral:
Yes
No |
Outstanding Debts and Other Obligations (If none please put "none" in the first box) |
*Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Additional Information |
|
References |
*Name |
*Relationship
|
*Address |
*Phone Number (
)
|
*Name |
*Relationship
|
*Address |
*Phone Number (
)
|
*Name |
*Relationship
|
*Address |
*Phone Number (
)
|
|
Co-Applicant Information |
Account Number (Existing Member) |
|
First Name |
Middle
Last Name
|
Date of Birth (MM/DD/YYYY) |
Social Security
|
Driver's License Number |
State
|
Number of Dependents |
List Ages of Dependents
|
E-mail Address |
|
Present Home Address |
Address Line 1 |
Line 2
|
City |
State
Zip
|
Own or Rent |
Own
Rent
Live w/Family |
Monthly Mortgage/Rent Amount |
Years There
|
Home Phone Number |
(
)
Cell
(
)
|
Employment Information |
Employer Name |
Monthly Gross Income
|
Start Date (MM/DD/YYYY) |
Work Phone Number
(
)
|
Previous Employer (If current employment less than 2 years) |
|
Additional Income |
Additional Income Type |
|
Additional Amount |
Frequency
|
Additional Information |
|
References |
Name |
Relationship
|
Address |
Phone Number (
)
|
Name |
Relationship
|
Address |
Phone Number (
)
|
Name |
Relationship
|
Address |
Phone Number (
)
|
|
Deposits at other Financial Institutions (If none please put "none" in the first box) |
Financial Institution Name |
Account #
Checking
Savings
|
Financial Institution Name |
Account #
Checking
Savings |
Financial Institution Name |
Account #
Checking
Savings |
Financial Institution Name |
Account #
Checking
Savings |
Clear Title Assets (Car/Property) (If none please put "none" in the first box) |
Asset |
Value
Currently Pledged as Collateral:
Yes
No |
Asset |
Value
Currently Pledged as Collateral:
Yes
No |
Outstanding Debts and Other Obligations (If none please put "none" in the first box) |
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
Creditor
|
Balance
Monthly Payments
|
|
By clicking the submit button below I understand and agree to the following:
The Local Federal Credit Union will require information pertaining to my credit worthiness and I agree that the credit union shall be allowed to consult whomever it deems necessary for that purpose and I hereby release them from all liability therefore. I hereby certify that the foregoing statements are made for the purpose of obtaining a loan and are true, complete and correct to the best of my knowledge and belief. I also agree and attest that my name and address shown herein is my legal name and the place of my residence, and such address is the proper address for all notice(s) required by this agreement, and I further understand that any changes in this address must be submitted to us in writing to be effective.
You promise that the information stated in this Loan Application is true and correct to the best of your knowledge. 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. 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.
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. |
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