___________________________ _________________ _________________ _________________
________________________________________________________________ _______________________________ ___________________
.
.
CREDIT LINE ACCOUNT
AND PERSONAL LOAN APPLICATION
1325 Oxford Drive Allentown, PA 18103
(610) 791-2376 FAX (610) 791-2900
$
$
$
$
$
$
$
$
$
$
ACCOUNT NUMBER - APPLICANT ACCOUNT NUMBER - CO-APPLICANT DATE
Applicant Information
PRINT OR TYPE ALL INFORMATION
1. If You live in a community property state, are You:
Married Separated Unmarried (Includes Single, Divorced and Widowed)
2. Married applicants can apply for an individual loan. Indicate if You want an:
Individual Loan Joint Loan with Your Spouse/Co-Applicant
3. Method of Payment:
Payroll Deduction Automatic Share Transfer Cash Payment
4. Frequency of Payment: Weekly Bi-Weekly Semi-Monthly Monthly
Spouse/Co-Applicant Information
5. Complete Spouse/Co-Applicant Information only if:
a. This is for a joint account with Your Spouse or other Co-Applicant.
b. Your Spouse will use Your Account.
c.
You are relying on Your Spouse's income as a source of repayment for the credit requested.
d. You live in a community property state Arizona, California, Idaho, Louisiana,
Nevada, New Mexico, Texas, Washington, Wisconsin (and Puerto Rico).
6. Definitions:
Whenever used in this application the words You and Your refer to the Applicant(s)
or Spouse/Co-Applicant and the words We, Us, and Our refer to the Lender.
Credit Applied For:
Type of credit Amount Requested $ Refinanced Amount $ Total Request $
Purpose Collateral Offered Value $
There are costs associated with the use of any Credit Card issued to You by Us. You may request specific information about these
costs by contacting Us by telephone at (610) 791-2376 (callers from outside the 610 area code may call collect), or by writing to
Us at 1325 Oxford Drive, Allentown, PA 18103.
APPLICANT OR CO-SIGNER
own; rent; live with other
FIRST NAME INITIAL
LAST NAME
SOCIAL SECURITY NUMBER
BIRTHDATE
CURRENT STREET ADDRESS
APT.
SINCE (MO. YR.)
CITY
STATE
ZIP
COUNTY
EMAIL ADDRESS
FORMER ADDRESS (COMPLETE IF PREVIOUS ADDRESS IS LESS THAN 3 YEARS) YEARS THERE
CELL PHONE
HOME PHONE
NO. OF DEPS
AGES OF DEPENDENTS
NAME, ADDRESS AND PHONE NUM BER OF NEAREST RELATIVE NOT LIVING WITH YOU
EMPLOYMENT AND INCOME If self-employed or retired, attach financial statement or income tax returns.
CURRENT EMPLOYER (INCLUDE EMPLOYEE I.D. IF APPLICABLE)
EMPLOYMENT DATE
ADDRESS/CI TY/STATE/ZIP
WORK PHONE
POSITION
MO. GROSS INCOME
$
FORMER EMPLOYER
POSITION
YEARS
OTHER INCOME You need not list income from alimony, child support, or separate maintenance payments unless You want it considered in evaluating this credit application.
TYPE OF OTHER INCOME
MONTHLY AMOUNT
$
NAME AND ADDRESS OF PAYER
ASSETS AND DEPOSITS Attach a separate sheet if necessary.
TYPE
BANK (OR OTHER) NAME, ADDRESS
AC
COUNT NO.
APPROX. BAL.
VALUE
$
VALUE
$
HOMEOWNERS: PLEASE INDICATE NAME(S) ON DEED
PURCHASE PRICE
APPROX. VALUE
SPOUSE/CO-APPLICANT
own; rent; live with other
FIRST NAME INITIAL LAST NAME
SOCIAL SECURITY NUMBER
BIRTHDATE
CURRENT STREET ADDRESS
APT.
SINCE (MO. YR.)
CITY STATE
ZIP
COUNTY
EMAIL ADDRESS
FORMER ADDRESS (COMPLETE IF PREVIOUS ADDRESS IS LESS THAN 3 YEARS) YEARS THERE
CELL PHONE
HOME PHONE
NO. OF DEPS
AGES OF DEPENDENTS
NAME, ADDRESS AND TELEPHONE OF NEAREST RELATI VE NOT LIVING WITH YOU
CURRENT EMPLOYER (INCLUDE EMPLOYEE I.D. IF APPLICABLE)
EMPLOYMENT DATE
ADDRESS/CITY/STATE/ZIP
WORK PHONE
POSITION
MO. GROSS INCOME
FORMER EMPLOYER
POSITION
YEARS
TYPE OF OTHER INCOME
MONTHLY AMOUNT
NAME AND ADDRESS OF PAYER
TYPE
BANK (OR O
THER) NAME, ADDRESS
ACCOUNT NO.
APPROX. B
AL.
VA
LUE
$
VALUE
$
HOMEOWNERS: PLEASE INDICATE NAM E (S) ON DEED
PURCHASE PRICE
$
APPROX. VALUE
$
Copyright Oak Tree Business Systems, Inc., 1998-2015. All Rights Reserved.
Page 1 of 2
OTBS 015 ALEN (5/15)
CREDIT INFORMATION
Please list all open accounts with or without a balance. Attach separate sheet if necessary.
A = Applicant C = Spouse/Co-Applicant
D = Debts to be paid off if loan is granted
PLEASE
CHECK
ACD
OBLIGATION
S
LENDER (OR OTHER) NAME, ADDRESS
LIST ALL OBLIGATIONS AND CREDIT UNION LOANS
ACCOUNT
NUMBER
INTEREST
RATE
ORIGINAL
AMOUNT
BALANCE
MONTHLY
PAYMENT
Please answer the following questions.
If a yes answer is given, explain on an attached sheet.
A C
Yes No Yes No
1. Have You filed a petition for bankruptcy in the last 14 years?
2. Have You ever had any auto, furniture or property repossessed?
3. Are You a co-maker or co-signer on any loan?
For Whom _______________________ Amount $______________
4. Have You ever had credit in any other name?
What Name______________________________________________
______________
______________
5. Have You any suits pending, judgments filed, alimony or support
awards against You?
____________________________________________________
TOTALS $
$
Please Check: A = Applicant C = Spouse/Co-Applicant
A
Yes No
C
Yes
No
6. Have You any obligations not listed?
7. Do You have any past due bills?
8. Is any income You have listed likely to reduce in the next 2 years?
9. Indicate immigration status:
Applicant U.S. Citizen Permanent U.S. Resident Other
Co-Applicant U.S. Citizen Permanent U.S. Resident Other
OPTIONAL CREDIT INSURANCE An appropriate application/disclosure will be furnished at the time Your credit is approved.
You are interested in Credit Disability Insurance - single coverage
You are interested in Credit Life Insurance - single coverage
joint coverage
You are not interested in Credit Insurance
SIGNATURES
You warrant the truth of the above information and You realize that it will be relied upon by Us in deciding whether or not to grant the credit applied for. You
hereby authorize Us, Our employees and agents to investigate and verify any information provided to Us by You. If this application is for any Feature Category
contained in Our Credit Line Account Program, You agree and understand that if approved, You are contractually liable according to the applicable terms of the
Credit Line Account Agreement and Disclosure. You acknowledge receiving a copy of that Agreement and promise to pay all amounts charged to Your
Account according to its terms. If this is a joint application, You agree that such liability is joint and several. You authorize Us to accept Your facsimile
signatures on this application and agree that Your facsimile signature will have the same legal force and effect as Your original signature. You assumeany risk
that may be associated with permitting Us to accept Your facsimile signature. If You are issued a credit card, by signing below, You grant and consent to a
lien on Your shares with Us (except IRA and Keogh Accounts) and any dividends due or to become due to You from Us to the extent You owe on any unpaid
credit card balance.
You hereby acknowledge Your intent to apply for joint credit
Applicant's Initials Co-Applicant's Initials
APPLICANT OR CO-SIGNER
SIGNATURE
DATE
SPOUSE/CO-APPLICANT
SIGNATURE
DATE
LOAN OFFICER
LOAN APPROVED
YES
NO
REFERRED TO CC
COUNTER OFFER WILL BE MADE IF ACCEPTED, LOAN APPROVED.
CREDIT MANAGEROROTHER
LOAN APPROVED
YES
NO
COUNTER OFFER WILL BE MADE IF ACCEPTED, LOAN APPROVED.
DESCRIBE COUNTER OFFER:
SPECIFIC REASON(S) FOR REJECTION/APPROVAL:
LOAN OFFICER SIGNATURE DATE
ADDITIONAL INFORMATION:
CREDIT MANAGEROROTHER DATE
ECOA NOTICE AND REASON FOR REJECTION OR UNACCEPTED COUNTER OFFER SENT OR DELIVERED ON (DATE) BY
Copyright Oak Tree Business Systems, Inc., 1998-2015. All Rights Reserved.
Page 2 of 2
OTBS 015 ALEN (5/15)
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