Apply For a Loan Your Email Address: Is this your first loan from us? Yes No Amount/Credit Limit Requested: $ How many months to repay? Loan Type: Select OneNew AutoUsed AutoSignatureSignature Line of CreditShare SecuredOther (Specify) Security Offered: Type of Credit: IndividualJoint Payment Protection Coverage Check if desired Are you interested in having your loan protected? Yes No If you answered “yes”, the credit union will disclose the cost to protect your loan. the credit insurance is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions. Applicant Co-Applicant Name: Name: CU Account #: CU Account #: Social Security #: –– Social Security #: –– Marriage Status: Marriage Status: Driver’s License State: Driver’s License State: Driver’s License #: Driver’s License #: Birth Date: Birth Date: Home Phone: Home Phone: Business Phone: Business Phone: Current Address: Current Address: Years There: Years There: Rent or Own: Rent Own Rent or Own: Rent Own Debts Debts Mortgage/Rent owed to: Mortgage/Rent owed to: Balance (Mortgage Only): Balance (Mortgage Only): Monthly Payment: Monthly Payment: Current APR % (Mortgage Only): Current APR % (Mortgage Only): Person responsible for payment: Person responsible for payment: Income Income Employer: Employer: Job title: Job title: Length of Employment: Length of Employment: Income: Income: Other income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not want it considered as a basis for repaying this obligation) Other income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not want it considered as a basis for repaying this obligation) Source: Source: Amount: Amount: By clicking Submit the Loan below you are promising that everything you have stated in this request is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any changes in your name, address or employment within a reasonable amount of time thereafter. You authorize the credit union to obtain credit reports in connection with this request. 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. You understand that it is a Federal crime to willfully and deliberately provide incomplete or incorrect information on requests made to Federal Credit Unions or State Chartered Credit Unions insured by the NCUA. You understand that the credit union will rely on the information in the request and your credit report to make its decision.