Loan Request

* denotes a required field

Purpose:*
 Term Requested:*
 Amount Requested:*

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. You are relying on your spouse's income as a basis for repayment.

Joint Credit: If you are applying with another person, complete the Applicant and Other sections.

Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Personal Information
Name:* Social Security #:*
Address:* Date of Birth:*
City:* Home Phone:*
State:* Email Address:
Zip:*
Financial/Employment Information
Employer:* Monthly Mortgage/Rent:*
Employer Address:* CU Acct. #:*
Employer City:* Work Phone:*
Employer State:* Length of Employment:*

Complete the following only if you reside in a community-property state (Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin); or if another person will be jointly liable on the account.
Marital Status:*   Married   Separated   Unmarried/Divorced
Total Monthly Gross Income (Employment)
Applicant:* Co-Applicant:
Other Income Information
Applicant: Co-Applicant:
Source:   Co-Applicant   Guarantor   Spouse
Name: Social Security #:
  Date of Birth:
Employer: Length of employment:

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

Please enter the two words you see below into the box below for verification
Disclosures

I (we) hereby certify that all statements made are true and complete and submitted for the purpose of obtaining credit. The credit union is authorized to check my (our) credit, employment history, obtain a credit report, and answer any questions about their credit history with me (us). Upon my (our) request, the credit union will tell me (us) the name and address of any credit bureau from which it received a report on me (us). I (we) understand that it is a federal crime to will fully and deliberately provide incomplete or incorrect information on loan applications made to Federal Credit Unions or State-Chartered Credit Unions insured by NCUA.