APPLICANT
OTHER
INTEREST
RATE
PRESENT
BALANCE
MONTHLY
PAYMENT
APPLICANT
OTHER
CREDITOR NAME OTHER THAN THIS CREDIT UNION
(Attach additional sheet(s) if necessary)
OWED BY
WHAT YOU OWE
OWNED BY
LIST LOCATION OF PROPERTY
OR FINANCIAL INSTITUTION
PLEDGED AS COLLATERAL
FOR ANOTHER LOAN
WHAT YOU OWN MARKET VALUE
APPLICANT OTHER
LIST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY
CAN BE CHECKED:
page 2 of 2
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
TOTALS
$ $
$
$
$
$
$
FOR CREDIT UNION USE ONLY
DATE SIGNATURE LINE OF CREDIT OTHER OTHER DEBT RATIO/SCORE
APPROVED
APPROVED
LIMITS:
BEFORE AFTER
DENIED
$ $ $ $
%
LOAN OFFICER COMMENTS:
SIGNATURES
X X
DATE DATE
NOYES
NOYES
NOYES
NOYES
NOYES
1. ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?
OTHER INFORMATION ABOUT YOU - IF YOU ANSWER "YES" TO ANY QUESTION OTHER THAN #1, EXPLAIN ON AN ATTACHED SHEET.
2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN
CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT?
3. IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?
4. ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE?
FOR WHOM (NAME OF OTHERS OBLIGATED ON THE LOAN): TO WHOM (NAME OF CREDITOR):
TOTAL
$
YES NO
YES
YES
YES
NO
NO
NO
NOYES
NO
NO
NO
YES
YES
YES
STATE NOTICES
OHIO RESIDENTS ONLY: 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: 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.
Spouse's SSN:
WISCONSIN RESIDENTS: Marital Status:
Spouse's Address (if different)
Legally Separated
MARRIED WISCONSIN RESIDENTS APPLYING FOR AN INDIVIDUAL ACCOUNT: By signing here, I state that the credit being applied for, if granted, will be incurred in the interest of the
marriage or family of the Borrower(s).
X
Married Unmarried
If married: the name of my spouse is
PLEASE READ BEFORE SIGNING:
Credit Report Authorization. By signing this Application, I authorize you to obtain my credit report for the purposes of evaluating this application and to obtain
subsequent credit reports on an on-going basis in connection with this transaction, and for all other legitimate purposes, such as reviewing my accounts or
taking collection action on the account. Vermont Residents: Applicant provided consent via phone _______________ (Credit Union Initials)
LOAN APPLICATION SIGNATURES
All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on
this application. You have my permission to check it. You may retain this application even if not approved. I understand that you may receive information from
others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. If
this application is approved, I agree to honor the provisions of the credit or loan agreement and security agreement covering my account or loan. (If this
application is for two of us, this statement applies to both of us.)
IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
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 me: When I open an account, you will ask for my name, address, date of
birth, and other information that will allow you to identify me. You may also ask to see my driver's license or other identifying information.
X
SIGNATURE OF APPLICANT DATE
HAVE YOU OMITTED ANYTHING? REMEMBER: INCOMPLETE APPLICATIONS CANNOT BE PROCESSED.
X
DATESIGNATURE OF CO-APPLICANT
(Adverse Action Notice sent)
Permission to contact: By providing a wireless telephone number (i.e., cell phone), I consent to receiving calls, including autodialed and prerecorded
message calls, from the credit union or its third party debt collector at that number.
