Loan Application Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information. Loan Information Type of Loan Amount Requested Will there be a co-applicant on this application? Choose One Personal New Auto Used Auto Recreational Vehicle/Boat Motor Home Unsecured Home Improvement Home Equity Share Secured Debt Consolidation Vacation $ YesNo Primary Applicant Member Number Last Name First Name Middle Name SSN (TIN) Date of Birth (mm/dd/yyyy) Age of Dependants Home Phone () -Second partThird part Work Phone () -Second partThird part Email Address Mother's Maiden Name Home Address Street City State Zip Code Type of Residence Monthly Payment OwnRentOther $ Time at Current Residence Years: Months: 0 1 2 3 4 5 6 7 8 9 10 11 Previous Address if Less Than 2 Years Street City State Zip Code Type of Residence Monthly Payment OwnRentOther $ Other Income Source 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. Present Employer Name Phone Number () -Second partThird part Employment Status Full TimePart TimeTempRetiredOther Other Job Title Job Start Date (mm/dd/yyyy) Gross Salary Other Income $ Per Year Month Hour $ Per Year Month Hour Previous Employer if Less Than 2 Years Name Phone Number () -Second partThird part Employment Status Full TimePart TimeTempOther Other Job Title Job Start Date (mm/dd/yyyy) Gross Salary Other Income $ Per Year Month Hour $ Per Year Month Hour Co-Applicant Member Number Last Name First Name Middle Name SSN (TIN) Date Of Birth (mm/dd/yyyy) Age of Dependants Home Phone () -Second partThird part Work Phone () -Second partThird part Email Address Mother's Maiden Name Home Address (Co-Applicant) Street City State Zip Code Type of Residence Monthly Payment OwnRentOther $ Time at Current Residence Years: Months: 0 1 2 3 4 5 6 7 8 9 10 11 Previous Address if Less Than 2 Years (Co-Applicant) Street City State Zip Code Type of Residence Monthly Payment OwnRentOther $ Other Income Source (Co-Applicant) 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. Present Employer (Co-Applicant) Name Phone Number () -Second partThird part Employment Status Full TimePart TimeTempRetiredOther Other Job Title Job Start Date (mm/dd/yyyy) Gross Salary Other Income $ Per Year Month Hour $ Per Year Month Hour Previous Employer if Less Than 2 Years (Co-Applicant) Name Phone Number () -Second partThird part Employment Status Full TimePart TimeTempOther Other Job Title Job Start Date (mm/dd/yyyy) Gross Salary Other Income $ Per Year Month Hour $ Per Year Month Hour References - Nearest Relative Not Living With You Last Name First Name Relationship Phone Number () -Second partThird part Address City State Zip Code 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. Debts Monthly Payments Credit Card $ $ $ $ $ $ $ $ Additional Information How would you prefer to be contacted? Home PhoneWork PhoneEmailOther Special Instructions/Comments Application Submission Income verification is required; other information may be required. I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Credit Union, information concerning me or my affairs. (Sec. 1014, Title 13, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application of a Federal Credit Union.) Prior to submitting this application, please enter the security code in the box below