Loan Application

Amount Requested $____________ Purpose: _______________________________ Security Offered:_______________________

________________________________________________ ______________________________________________

Name Applicant Name Co-Applicant

________________________________________________ ______________________________________________

Address Address

________________________________________________ ______________________________________________

City, State, ZIP City, State, Zip

___________________ _____________________ _____________________ _________________

Social Security Number Birth Date Social Security Number Birth Date

___________________ _____________________ _____________________ _________________

Home Phone Cell Phone Home Phone Cell Phone

Employment and Income

Applicant Co-Applicant

_______________________________________________ ______________________________________________

Name and Address of Employer Name and Address of Employer

$________ per ___________ ___________ $__________ per __________ ___________

Income Years on Job Income Years on Job

Other Income: Alimony, Child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. $

Debts

Applicant	Balance	Monthly Payment
Home (Own or Rent ?)
Co-Applicant	Balance	Monthly Payment
Home

Applicant Co-Applicant

Yes/No Yes/No

Have you ever filed for Bankruptcy chapter 7 or 13? ___ ___

Have you ever had property foreclosed upon or repossessed ? ___ ___

Do you have any outstanding judgments? ___ ___

Are you a co-maker or co-signer on any loan not listed above? ___ ___

A Yes answer to any of the above requires a written explanation.

By initialing below each applicant certify that they are applying for joint credit.

Initial: _____ Initial: _____

I hereby certify that all of the statements made are complete and correct. I authorize the Credit Union to verify my employment and to obtain and release credit information in connection with this application and any update, renewal or extension of any credit received. At my request, you will give me the name and address of the Credit Bureau(s) used. I understand that it is a Federal crime to willfully and deliberately provide incomplete or incorrect information on a loan application made to a Federal Credit Union.

____________________________ ________ _____________________ _________

Applicant's Signature Date Co-Applicant's Signature Date

For Credit Union Use Only: Approved or Denied by: Date: