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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