Loan Application Loanliner Account/Loan*IndividualJoint(Including ATM/Debit card access to the account if available)INSERT INITIALS FOR SIGNATURES BELOW Applicant Signature* Applicant Date* Amount Requested $* Purpose/Collateral* Credit Card Account*IndividualJointIf this is an application for joint credit, Applicant and Co-Applicant each agree and acknowledge the intent to apply for joint credit (sign below): Co-Applicant Signature* Co-Applicant Date Credit Limit Requested $* If Authorized User, Name Applicant Name (Last-First-MI)* Applicant Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Applicant Email* Applicant Home Phone* Applicant Cell Phone Applicant Work Phone Applicant Present Address (Street, City, State, Zip)* Applicant Present Residence*OwnRent Applicant Present Length at Residence* Applicant Previous Address (Street, City, State, Zip)* Applicant Previous Residence*OwnRent Applicant Previous Length at Residence* Applicant Mortgage/Rent Owed to* Applicant Monthly Payment* Applicant Mortgage Balance* Applicant Mortgage Interest Rate* Complete for joint credit, secured credit or if you live in a community property state:MarriedSeparatedUnmarried (Separated/Divorced/Widowed) OtherCo-ApplicantSpouseGuarantorOther Co-Applicant Name (Last-First-MI)* Co-Applicant Date of Birth01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Co-Applicant Email Co-Applicant Home Phone Co-Applicant Cell Phone Co-Applicant Work Phone Co-Applicant Present Address (Street, City, State, Zip) Co-Applicant Present ResidenceOwnRent Co-Applicant Present Length at Residence Co-Applicant Previous Address (Street, City, State, Zip) Co-Applicant Previous ResidenceOwnRent Co-Applicant Previous Length at Residence Co-Applicant Mortgage/Rent Owed to Co-Applicant Monthly Payment Co-Applicant Mortgage Balance Co-Applicant Mortgage Interest Rate Complete for joint credit, secured credit or if you live in a community property state (co-applicant):MarriedSeparatedUnmarried (Separated/Divorced/Widowed) Applicant Employment Start Date* Applicant Status*Full TimePart Time2 Applicant Employer Name & Address*Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered Applicant Employment Income* Applicant Job Title* Applicant Other Income Applicant Other Income Source Applicant Previous Employer Name & Address (if employed less than 5 years) Applicant Start & Ending Dates Applicant Military: Is duty station transfer expected during next year?YesNo Applicant Location & Ending/Separation Date Name & Address of Nearest Relative Not Living with Applicant* Relationship to Applicant* Applicant Reference Phone Number* Co-Applicant Employment Start Date Co-Applicant StatusFull TimePart Time2 Co-Applicant Employer Name & AddressNotice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered Co-Applicant Employment Income Co-Applicant Job Title Co-Applicant Other Income Co-Applicant Other Income Source Co-Applicant Previous Employer Name & Address (if employed less than 5 years) Co-Applicant Start & Ending Dates Co-Applicant Military: Is duty station transfer expected during next year?YesNo Co-Applicant Location & Ending/Separation Date Name & Address of Nearest Relative Not Living with Co-Applicant Relationship to Co-Applicant(1) Co-Applicant Reference Phone Number Applicant Monthly Rent* Applicant Mortgage Monthly Payment* Applicant Interest Rate* Applicant Present Balance* Please List Applicant Monthly Expenses With Related Creditors* Please List Applicant Balances With Related Creditors* Please List Applicant Assets With Property Location or Financial Institution & Market Value* Is The Applicant a US Citizen or Permanent Resident Alien?*YesNo 1) Does The Applicant currently has any outstanding judgements, filed for bankruptcy, had debt adjustment under Chapter 13, had property foreclosed or repossessed in the last 7 years or been a party in a lawsuit?*YesNo 1) If Yes, Applicant Explains 2) Is The Applicant Income Likely to Decline in the Next two Years?*YesNo 2) If Yes, Applicant Explains 3) Is The Applicant a Co-Maker, Co-Signer or Guarantor on any loan not listed above?*YesNo 3) If Yes, Applicant Explains with Names of Others on Loan & Name of Creditor* Co-Applicant Monthly Rent Co-Applicant Mortgage Monthly Payment Co-Applicant Interest Rate Co-Applicant Present Balance Please List Co-Applicant Monthly Expenses With Related Creditors Please List Co-Applicant Balances With Related Creditors Please List Co-Applicant Assets With Property Location or Financial Institution & Market Value Is The Co-Applicant a US Citizen or Permanent Resident Alien?YesNo 1) Does The Co-Applicant currently has any outstanding judgements, filed for bankruptcy, had debt adjustment under Chapter 13, had property foreclosed or repossessed in the last 7 years or been a party in a lawsuit?YesNo 1) If Yes, Co-Applicant Explains 2) Is The Co-Applicant Income Likely to Decline in the Next two Years?YesNo 2) If Yes, Co-Applicant Explains 3) Is The Co-Applicant a Co-Maker, Co-Signer or Guarantor on any loan not listed above?YesNo 3) If Yes, Co-Applicant Explains with Names of Others on Loan & Name of CreditorSTATE LAW NOTICE(S)Notice to Nebraska Residents: A credit agreement must be in writing to be enforceable under Nebraska law. To protect you and us from any misunderstandings or disappointments, any contract, promise, undertaking, or offer to forebear repayment of money or to make any other financial accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must be in writing to be effective.Notice to New York Residents: New York residents may contact the New York State Department of Financial Services to obtain a comparative listing of credit card rates, fees, and grace periods. New York State Department of Financial Services: 1-800-342-3736 or www.dfs.ny.gov.Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers,and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.Notice to Wisconsin Residents: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned. Signature & Date for Wisconsin Residents OnlyCONSENSUAL SECURITY INTERESTYou grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. Shares and deposits in an IRA or any other account that would lose special tax treatment under state or federal law if given as security are not subject to the security interest you have given in your shares and deposits. You may withdraw these other shares unless you are in default. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. For example, if you have an unpaid credit card balance, you agree we may use funds in your account(s) to pay any or all of the unpaid balance.By signing or otherwise authenticating below, you are affirmatively agreeing that you are aware that granting a security interest is a condition for the credit card and you intend to grant a security interest. You acknowledge and agree that your pledge does not apply during any periods when you are a covered borrower under the Military Lending Act. For clarity, you will not be deemed a covered borrower, and your pledge will apply, if: (i) you become obligated on a credit transaction or establish an account for credit when you are not a covered borrower; or (ii) you cease to be a covered borrower. Applicant Consensual Security Interest Signature & Date* Co-Applicant Consensual Security Interest Signature & DateSIGNATURESBy signing or otherwise authenticating below:1. You promise that everything you have stated in this application is correct to the best of your knowledge, and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a crime to willfully and deliberately provide incomplete or incorrect information in this application.2. If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the termsof the Consumer Credit Card Agreement and Disclosure. Applicant Final Signature & Date* Co-Applicant Final Signature & Date Enter Security Code & SUBMITSubmitReset
