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* Required Fields

    • General Information

    • Check below to indicate the type of account(s) and type of credit for which are applying. Married Applicants may apply for a separate account.
    • * Account/Loan:




    • Repayment:



    • Payment Protection
    • Payment Protection


    • Payment Protection Interested in:




    • 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.

    • Applicant






    • * Date of Birth
      / /
    • * Home Phone Number
      ( ) - ext
    • Business Phone Number/Ext.
      ( ) - ext
    • Best Method of Contact



    • Best Time to Contact




    • Present Address



    • * Residence Type




    • Previous Address if less than 2 years



    • ResidenceType



    • Complete for joint Credit, Secured Credit or if you live in a Community Property State




    • Applicant - Employment/Income



    • Job Start Date
      / /


    • 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.

    • Per



    • Income Amount



    • Income is per





    • Previous Employer
      If Employed Less Than 2 Years


    • Starting Date
      / /
    • Ending Date
      / /

    • Applicant Reference

    • Home Phone
      ( ) - ext

    • Co-borrower






    • Date of Birth
      / /
    • Home Phone Number
      ( ) - ext
    • Business Phone Number/Ext.
      ( ) - ext


    • Present Address



    • ResidenceType




    • Previous Address



    • Residence Type



    • Complete for joint Credit, Secured Credit or if you live in a Community Property State




    • Other - Employment/Income



    • Start Date
      / /


    • 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.

    • Per



    • Income Type



    • Income is per:





    • Previous Employer
      If Employed Less Than 2 Years


    • Starting Date
      / /
    • Ending Date
      / /

    • What You Owe
    • Rent/Mortgage







    • Owed By



    • Child Support / Alimony / Spousal Support




    • Other Information About You - Applicant
    • IF YOU ANSWER YES TO ANY QUESTION OTHER THAN #1, EXPLAIN ON ANY ATTACHED SHEET
    • 1. Are You A U.S. Citizen or Permanent Resident Alien?


    • 2. Do You Currently Have Any Outstanding Judgements Or Have You Ever Filed For Bankruptcy Had A Debt Adjustment Plan Confirmed Under Chapter 18, 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?





    • Other Information About You - Co-borrower
    • IF YOU ANSWER YES TO ANY QUESTION OTHER THAN #1, EXPLAIN ON ANY ATTACHED SHEET
    • 1. Are You A U.S. Citizen or Permanent Resident Alien?


    • 2. Do You Currently Have Any Outstanding Judgements Or Have You Ever Filed For Bankruptcy Had A Debt Adjustment Plan Confirmed Under Chapter 18, 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?





    • State Law Notices
    • Ohio Residents Only: the Ohio laws against discrimination require that all creditors make credit 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 course decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the terms, before the credit is granted or the account is opened. (2) Please initial below 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.


    • 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, renewal or extension of the credit received. You understand that the Credit Union will reply 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.
    • Applicant Signature _______________________________
    • Other Signature _________________________________

    • Security Code
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