AffinityOne FEDERAL CREDIT UNION LOAN APPLICATION
APPLICANT INFORMATION:
Full Name: Credit Union Account #:
Street Address:
Telephone #: Own Home Rent Other
Social Security #: Mortgage/Rent Payment: $
E-mail address: Value of Home: $
Date of Birth: Years at This Address:
Other Checking/Savings Balances: Value of Assets Owned:
LOAN INFORMATION:
Purpose of Loan: Term: Ideal Payment:
Amount Requested: Consolidation Loan Add to Current Loan
If auto is to be offered, complete the following & attach a copy of purchase agreement or original title:
Year: Make: Model:
Mileage: Dealership Name:
VIN # Color:
Temporary Disability Insurance: Yes No Life Insurance: Yes No
Payment Type: Month End Checking____ Month End Share____ Direct Pay ___ (Interest rate reduction may apply)
CREDIT INFORMATION
Name of Creditor Payment Balance Owed Name of Creditor Payment Balance Owed
1 3
2 4
EMPLOYER INFORMATION:
Present Employer: Position/Title:
Years with this Employer: Telephone #:
Gross Income**: Hourly $ Monthly$
Other Income**:
Full-Time Part-Time
Bankruptcy Filed:
Previous Employer (if employed less than 1 year):
Alimony or Child Support:
CO-APPLICANT INFORMATION:
Full Name: Credit Union Account #:
Address: Telephone #:
Social Security #: Date of Birth:
Present Employer: Years at this address:
Employer Telephone #:
Gross Income**: Monthly $ Yearly $
Previous Employer (if employed less than 1 year):
** Verification of income may be required. Alimony and child support income does not have to be revealed if the applicant does not want the Credit Union to consider it.
I hereby certify that all the statements made are true and submitted for the purpose of obtaining credit. I have no other debts. I also acknowledge receipt of the Equal
Opportunity Act Notice. "In considering this application the loan officer may request a report from outside reporting agencies. We may also ask a reporting
agency or agencies for other such reports in connection with renewal or continuation for which you're applying. If you request it, we will tell you whether or not we ask for such
reports and, if we have the names and addresses of the agency or agencies. I acknowledge notice of this disclosure under article 25 of the NYS General Business Law."
Signature of Applicant: Date:
Witness: Date:
I understand that by signing this statement, I become responsible for this debt should the applicant be delinquent.
Signature of Co-Applicant: Date:
Witness: Date:
FOR CREDIT UNION USE ONLY
Approved by Loan Officer: ____________________________________ on _______________
(Date)
(Office use only. Do not write.)
Distribution Type: ______________________________
New Loan $___________________
Note Number ____________________
Loan Officer Comments: ______________________________________________________
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