GENERAL APPLICANT INFORMATION

     Name 

     Street Address   

     City  State Zip 

     How long have you lived at this address?  years



If present residence less than two years, please complete;

     Previous Home Street Address  

     City   State   Zip  

     How long did you live at this address?  years
 


     Home Phone Number 

     Date Of Birth    

     # of Dependents 

     Age of Dependents  

     Social Security Number 

     Drivers License   , State                

     Business Phone Number  

     Gross Annual Income  $			

     Net Monthly Income  $



     Present Employer 

     Position   

     How Long?  

     Present Employer Street Address   

     City  State Zip 



If at present employer less than three years, please complete;

     Previous Employer 

     Position   

     How Long?  

     Previous Employer Street Address   

     City  State Zip 

GENERAL CO-APPLICANT INFORMATION

     Name 

     Street Address   

     City  State Zip 

     How long have you lived at this address?  years



If present residence less than two years, please complete;

     Previous Home Street Address  

     City   State   Zip  

     How long did you live at this address?  years
 


     Home Phone Number 

     Date Of Birth    

     # of Dependents 

     Age of Dependents  

     Social Security Number 

     Drivers License   , State                

     Business Phone Number  

     Gross Annual Income  $			

     Net Monthly Income  $



     Present Employer 

     Position   

     How Long?  

     Present Employer Street Address   

     City  State Zip 



If at present employer less than three years, please complete;

     Previous Employer 

     Position   

     How Long?  

     Previous Employer Street Address   

     City  State Zip 

Alimony, child support, or separate income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

APPLICANT INFORMATION

     Alimony, child support, separate maintenance received under:

      Court Order    Written Agreement   Oral understanding

     Other income: $ per  source(s) of other income:


     

     Is any income in the Section likely to be reduced in the next 2 years?

      Yes        No

CO-APPLICANT INFORMATION

     Alimony, child support, separate maintenance received under:

      Court Order    Written Agreement   Oral understanding

     Other income: $ per  source(s) of other income:


     

     Is any income in the Section likely to be reduced in the next 2 years?

      Yes        No

OUTSTANDING DEBTS
(include charge accounts, installment contracts, credit cards, rent, mortgages, etc.)

     Mortgagee or Landlord 

     Payment Address 

     Approximate Market Value  $

     Original Amount  $ Balance Due  $      

     Monthly Payment/Rent  $

LIST AUTO OWNED

     1) Make Year 

     License #  

     Financed by 

     Original Amount  $ Balance Due  $

     Monthly Payment  $

OTHER DEBTS

     1) Name & Payment Address 

     Account #

     Original Amount / Credit Limit $ Balance Due  $      

     Monthly Payment  $



     2) Name & Payment Address 

     Account #

     Original Amount / Credit Limit $ Balance Due  $      

     Monthly Payment  $



     3) Name & Payment Address 

     Account #

     Original Amount / Credit Limit $ Balance Due  $      

     Monthly Payment  $



     4) Name & Payment Address 

     Account #

     Original Amount / Credit Limit $ Balance Due  $      

     Monthly Payment  $

BANK BALANCE

     Checking/Share Draft Account # 

     Location 

     Savings/Share Account # 

     Location 

     Total $

Name of nearest relative not living with you 

     Address (City, State, Zip) 

     Relationship 



     Are you the comaker, endorser, or guarantor on any loan or contract

     Yes  No  

     If "yes" for whom? 

     To whom? 



     Are there any unsatisfied judgements against you?

     Yes  No

     If "yes" for whom? 

     Amount $



Other obligations - (E.g., liability to pay alimony, child support, etc.)

     



Have you ever had a car or other personal property repossessed by a dealer
or finance company, filed for bankruptcy, or been party to a wage assignment
or collection suit, or have you ever been declined on a loan application to
this credit union?                 

     Yes  No

     If your answer to any part of this question is "yes", please give
     details.

      



*Complete the following only if you reside in a community property state
(Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas,
Washington, or Wisconsin); or if another person will be jointly liable for
the account.

     Married         Separated         Unmarried