General Information


(If Joint, the co-applicant section has the same required fields as the primary applicant.)



Complete marital status if this loan is for:
a) Joint or secured credit, or
b) You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)












Are you interested in having your loan protected?*



(If you answer “yes”, then the credit union will disclose the cost of this voluntary payment protection to you.
A separate election which discloses the terms and conditions must be signed for protection to be effective.)

Primary Applicant







   








 

Home Address











 

Previous Address








 

Present Employer











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.






 

Previous Employer











Co-Applicant















 

Home Address











 

Previous Address








 

Present Employer











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.






 

Previous Employer










References

Nearest Relative Not Living With You










Debts / Monthly Payments

List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support,
child care, medical, utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan.













Additional Information




I authorize any person, association, firm or corporation to furnish,
on request of this Financial Institution, information concerning me
or my affairs. (Sec. 1014, Title 18, U.S. Code makes it a Federal
Crime to knowingly make a false statement on this application.)