CREDIT UNION:
Marshland Community Federal Credit Union
3650 Community Road
Brunswick, GA 31520
(912) 279-2000
Date:
SIMPLIFIED LOAN PROGRAM
APPLICATION
MARRIED APPLICANTS may apply for a separate account. A Credit Union may only extend direct credit to a member. Any Joint applicant for credit will be
considered a guarantor or co-signer if such person is not a credit union member. Check the type of credit account you wish to apply for.
Individual Credit – You must complete the applicant section about yourself and the other section about your spouse if: (1) You live in a community property state
(AK, AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI); (2) your spouse will use the account; or (3) you are relying on your spouse’s income as a source of repayment.
Joint Credit – If you are applying for a joint account or an account that you and another person will use, you must complete the applicant and other section.
If you intend to apply for joint credit, you understand that the Credit Union may need to document any non-member as a guarantor/co-signer as explained above.
Applicant Signature__________________________________________ Co-Applicant Signature _________________________________________________
Account:
Amount Requested:
Purpose or Collateral:
Repayment:
If this application is used to issue a credit card, you understand that your use or allowing the card to be used will constitute acknowledgment and receipt and
agreement to the terms and conditions of the credit card agreement provided to you with the card.
APPLICANT
Complete for joint credit or if you live in a community property state:
!
Married
!
Separated
!
Unmarried (single, divorced, widowed)
Name:
Social Security No.
Driver’s License No.
Email (Home)
Account Number
Security Authentication Birthdate No. of Dependents Home Phone Business Phone
! Own ! Rent
Monthly Payment
Present Address
Years There
Mortgage/ Rent to:
Balance
Start Date
Name and address of employer
Start Date Employment Income Previous employer name and address
End Date
Notice: Income from alimony, child support, or separate maintenance payments need not be revealed if you do not choose to have it considered.
Other Income
Amount Period Source Amount Period Source
Name and address of nearest relative not living with you
Relationship Phone
OTHER APPLICANT CO-BORROWER SPOUSE GUARANTOR
Complete for joint credit or if you live in a community property state:
!
Married
!
Separated
!
Unmarried (single, divorced, widowed)
Name:
Social Security No.
Driver’s License No./State
Email (Home)
Account Number
Security Authentication Birthdate No. of Dependents Home Phone Business Phone
! Own ! Rent
Monthly Payment
Present Address
Years There
Mortgage/ Rent to:
Balance
Start Date
Name and address of employer
Start Date Employment Income Previous employer name and address
End Date
Notice: Income from alimony, child support, or separate maintenance payments need not be revealed if you do not choose to have it considered.
Other Income
Amount Period Source Amount Period Source
Name and address of nearest relative not living with you
Relationship Phone
Copyright 2004
ConmarSystems, Inc.,
Peachtree City, GA 30269- Rev. 4/04 E-FORM WD_200 EF 56449-1 page 1
Continued on Page 2
Deposits at other Financial Institutions
Clear title assets (Car/Property)
Value: Pledged as collateral
OUTSTANDING DEBTS AND OTHER OBLIGATIONS
Creditor Account No. Balance Monthly Payments
ARE YOU A UNITED STATES CITIZEN?
APPLICANT
OTHER APPLICANT
! YES ! NO
! YES ! NO
Do you have any outstanding judgements, ever filed bankruptcy, had debt adjustment
plan confirmed under Chapter 13, had property foreclosed upon or repossessed in
last 7 years?
Is any income you have shown likely to reduce in the next two years?
Are you a co-maker or co-signer on any loan? If so, whom?
NAME OF OTHERS OBLIGATED ON LOAN AND NAME OF CREDITOR
IF ANY YES, EXPLAIN
APPLICANT
! YES ! NO
! YES ! NO
! YES ! NO
OTHER APPLICANT
! YES ! NO
! YES ! NO
! YES ! NO
. . . . IF NO LIST STATUS
STATE NOTICES
OHIO RESIDENTS ONLY: The Ohio laws against discrimination requires that all creditors make credit equally available to all credit worthy 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.
WISCONSIN RESIDENTS ONLY: For any provision of any marital property agreement, court decree order section 766.70, or statement under section 766.59
to adversely affect the rights of the Credit Union, the Credit Union must be provided with a copy of the Agreement, decree or statement or have actual
knowledge of its terms before any credit is approved or account opened. Sign if you are NOT applying for this loan account with your spouse. This credit
request, if approved, will be incurred in the interest of the marriage or family of the undersigned.
Wisconsin Resident Only Date
SIGNATURES
You promise that the information stated in this TotaLoan Simplified Loan Program Application is true and correct to the best of your knowledge. The Credit Union or its
agent is authorized to investigate your credit worthiness, employment history, and to obtain a credit report and to answer questions about its credit history with you. The
Credit Union may also obtain credit reports to update, increase, extend or renew credit with you. False or misleading statements in your application may cause any loan
to be in default. You agree that this application shall be the Credit Union’s property whether or not this application is approved. You will notify the Credit Union in writing
immediately of any changes in your name, address or employment. You understand that it is a crime to willfully and deliberately provide incomplete or incorrect
information to obtain credit. If you request, you will be provided the name and address of any credit bureau from which we received a credit report. If this application is
used to issue a credit card, by signing below or by using or allowing the card to be used, you agree to all the terms and conditions of the credit card agreement
provided to you with the credit card.
As security for any loan advance to you or on your behalf, under the TotaLoan Simplified Loan Agreement and Disclosure, you grant the Credit
Union a Security Interest in all individual and joint share or other accounts you have with the Credit Union now and in the future. When you are in
default you authorize the Credit Union to take that money and apply it to what you owe. Shares and deposits that would have an adverse tax
consequence if pledged as security are not subject to this Security Interest.
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 you: When you open an account, we will ask your name, address, date of
birth, and other information that will allow us to identify you. We may also ask to see your driver's license and other identifying information.
X
(seal)
X
(seal)
Applicant Date Other Applicant Date
CREDIT ACTION
APPROVED (subject to special conditions set forth below):
By:
!
ECOA Notice and reason for Rejection sent or delivered on ____________
DISAPPROVED (for the following reason):
The following counter offer will be made to the applicant and if accepted, we
approve the loan.
Describe: _____________________________________________________
_____________________________________________________________
Outside information considered: ! NO ! YES Describe: _______________
_____________________________________________________________
By: __________________________________________________________
Copyright 2004
ConmarSystems, Inc.,
Peachtree City, GA 30269- Rev. 4/04 E-FORM WD_200 EF 56449-1 page 2
TotaLoan to be reproduced only with permission of ConmarSystems, Inc
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