Individual Credit Joint Credit Amount Requested $ Purpose Repayment: Payroll Deduction Cash Automatic Payment Military Allotment
Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective. Credit Disability Insurance Single Credit Life Insurance Joint Credit Life Insurance
Name (Last, First M.I.) Street Address City State Zip How long have you lived at this address? years Did you: Own Rent 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 Did you: Own Rent Home Phone Number () Business Phone Number () Date Of Birth Social Security Number Drivers License , State Account Number *Complete for Joint Credit, Secured Credit or if you live in a Community Property state: Married Separated Unmarried List ages of dependents not listed by other applicant (exclude self)
Co-Applicant Spouse Name Street Address City State Zip How long have you lived at this address? years Did you: Own Rent 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 Did you: Own Rent Home Phone Number () Business Phone Number () Date Of Birth Social Security Number Drivers License , State Account Number *Complete for Joint Credit, Secured Credit or if you live in a Community Property state: Married Separated Unmarried List ages of dependents not listed by other applicant (exclude self)
Present Employer Present Employer Street Address City State Zip Position Supervisor's Name Start Date Hours at Work If Self-Employed, Type of Business If at present employer less than three years, please complete; Previous Employer Previous Employer Street Address City State Zip Starting Date Ending Date Military; Is Duty Station Transfer expected during the next year? Yes No If yes, where Ending / Separation Date
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
Name of nearest relative not living with you Address (City, State, Zip) Phone Number Relationship Name of personal friend (not a relative) Address (City, State, Zip) Phone Number
This statement is submitted to obtain credit and I (we) certify that all information herein is true and complete. I (We) also authorize the Credit Union to verify or obtain further information the Credit Union may deem necessary concerning my (our) credit standing. If this application is approved and Line of Credit is issued, the applicant(s) by pressing the "Submit this Application" button below, agree(s) that the applicant(s) will be bound by the terms and conditions accompanying the Line of Credit and all amendments.
