LOANLINER Application

* indicates a required field

Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

  1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI).
  2. your spouse will use the account, or
  3. your are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, completed the Other section to the extent possible about the person on whose payments you are relying.
Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.


I. Loan Type

Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account.

*LOANLINER Account/Loan

Individual
Joint
(Including ATM/Debit Card Access to the Account if Available)
*Amount Requested $
*Purpose/Collateral  
*Repayment:
Payroll Deduction
Cash
Military Allotment
Automatic Payment


II. Applicant

*Name (First M Last Suffix)
Mother's Maiden Name
*Account Number
*Social Security Number - -
*Drivers License Number and State
*Ages of Dependants
E-mail
*Date of Birth (mm/dd/yyyy) / /
*Home Phone Number ( ) -
*Business Phone / Ext. ( ) -
Address:
*Present Address
*City, State Zip code ,
*Do you own or rent Own   Rent   Other
*Length at Residence
*Previous Address
*City, State Zip code ,
Do you own or rent Own   Rent   Other
Length at Residence
*Complete for Joint Credit, Secured Credit of if you live in a community property state:
Married   Separated   Unmarried (Single-Divorced-Widowed)
Employment / Income:
*Company Name
*Physical Address
*City, State Zip code ,
*Title/Grade
*Start Date / /
*Hours at Work
Supervisor's Name
If Self Employed, Type of Business
NOTICE: Alimony, Child Support, or separate maintenance income need not be revealed if you do not choose to have it considered.
*Employment Income $ per   Net   Gross
Other Income $ per
Source
(required if Other Income is completed)
Military: Is Duty Station Transfer expected during the next year? Yes     No
Where
Ending / Separation Date
Previous Employer:
(If employed less than 5 years)
Company Name
Physical Address
City, State Zip code ,
Starting Date / /
Ending Date / /
Reference
Name and Address of nearest relative not living with you.
*Name (First M Last Suffix)
*Present Address
*City, State Zip code ,
*Relationship
*Home Phone Number ( ) -

Co-Applicant   Spouse   Other

III. Other

Name (First M Last Suffix)
Mother's Maiden Name
Account Number
Social Security Number - -
Drivers License Number and State
Ages of Dependants
E-mail
Date of Birth (mm/dd/yyyy) / /
Home Phone Number ( ) -
Business Phone / Ext. ( ) -
Address:
Present Address
City, State Zip code ,
Do you own or rent Own   Rent   Other
Length at Residence
Previous Address
City, State Zip code ,
Do you own or rent Own   Rent   Other
Length at Residence
Complete for Joint Credit, Secured Credit of if you live in a community property state:
Married   Separated   Unmarried (Single-Divorced-Widowed)
Employment / Income:
Company Name
Physical Address
City, State Zip code ,
Title/Grade
Start Date / /
Hours at Work
Supervisor's Name
If Self Employed, Type of Business
NOTICE: Alimony, Child Support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income $ per   Net   Gross
Other Income $ per
Source
(required if Other Income is completed)
Military: Is Duty Station Transfer expected during the next year? Yes     No
Where
Ending / Separation Date
Previous Employer:
(If employed less than 5 years)
Company Name
Physical Address
City, State Zip code ,
Starting Date / /
Ending Date / /
Reference
Name and Address of nearest relative not living with you.
Name (First M Last Suffix)
Present Address
City, State Zip code ,
Relationship
Home Phone Number ( ) -

*IV. What You Owe

 Creditor Name Other Than
This Credit Union
(attach additional
sheet(s) if necessary)		Interest
Rate		Present
Balance		Monthly
Payment		Owed By
ApplicantOther
Rent
First Mortgage
(P&I only) 		$ $
2nd Mortgage $ $
1st Auto Loan $ $
2nd Auto Loan $ $
Child-Care $ $
Child Support $ $
Credit Card $ $
Credit Card $ $
Other $ $
Other $ $
List any names under which your credit references and credit
history can be checked:		 Totals $ $    

*IV. What You Own

 List location of property
or financial institution		Market
Value		Pledged as
collateral for
another loan		Owned By
YesNoApplicantOther
Home $
Auto $
Savings $
Checking $
Other
(describe)		 $

VI. Other Information About You

If you answer "yes" to any question other than #1, explain on an attached sheet.

 ApplicantOther
1)     *Are you a U.S. citizen or permanent resident alien?
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 Loan):

____________________________________________

To whom (Name of Creditor):

____________________________________________ 		 

VII. State Law 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.

WISCONSIN RESIDENTS ONLY:
(1) 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. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.


______________________________________________________________
Signature for Wisconsin Residents OnlyDate

VIII. Signatures

You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension or collection of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.


______________________________________(Seal)___________________________
Applicant's SignatureDate
 
______________________________________(Seal)___________________________
Other SignatureDate

* indicates a required field