Married Applications: May apply for a separate account.
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. |
your spouse will use the account, or |
| 3. |
you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying. |
Joint Credit: If you are applying with another person, complete the Applicant and Other sections.
Guarantor: Complete the Other section if you are guarantor on an account/loan. |
LOANLINER Account/Loan:
(Including ATM/Debit Card Access to the Account if Available)
| Amount Requested $ _______________________ |
| Purpose/Collateral: _______________________ |
| Repayment: |
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APPLICANT
| NAME _________________________________________ |
ACCOUNT NUMBER___________ |
| SOCIAL SECURITY NO. ______________________ |
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| DRIVER LICENSE NUMBER |
/STATE |
| ___________________/_________ |
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| PRESENT ADDRESS: _________________________ |
CITY:________________
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STATE:__________ |
| ZIP:_________________ |
LENGTH AT RESIDENCE:__ |
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| BIRTH DATE _____________ |
| HOME PHONE ________________ |
| BUSINESS PHONE/EXT ____________ |
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| WHAT YOU OWE |
| WHAT YOU OWE |
CREDITOR/NAME OTHER THAN THIS CREDIT UNION
(ATTACH ADDITIONAL SHEETS IF NECESSARY) |
% RATE |
PRESENT BALANCE |
MONTHLY PAYMENT |
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LIST ANY NAME UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED:________________________
_____________________________________ __________________________________ _______________________________
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COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE
STATE:________________
MARITAL STATUS:_________________
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| OTHER INFORMATION ABOUT YOU (IF YOU ANSWER "YES" TO ANY QUESTION ORTHER THAN #1, EXPLAIN ON AN ATTACHED SHEET) |
| 1. ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?________________________________ |
| 2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EvER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13, 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? _____________
FOR WHOM (Name of Others Obligated on Loan):________________________________________ TO WHOM (Name of Creditor)______________________ |
EMPLOYMENT AND INCOME
NAME AND ADDRESS OF EMPLOYER____________________
CITY:____________________
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STATE:__________ |
| ZIP:__________________ |
TITLE:_______________________ |
| SUPERVISOR'S NAME:_____________________________ |
| IF SELF EMPLOYED, TYPE OF BUSINESS:____________________________________ |
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$
__________
PER__________
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| START DATE________________ |
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| MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING THE NEXT YEAR? |
| WHERE:____________________________________________ |
ENDING/SEPARATION DATE:___________________________ |
OTHER INCOME
ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
| OTHER INCOME |
$ _____________ |
PER _____________ |
SOURCE ________________________________ |
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$ _____________ |
PER _____________ |
SOURCE ________________________________ |
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$ _____________ |
PER _____________ |
SOURCE ________________________________ |
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$
_____________
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PER _____________ |
SOURCE ________________________________ |
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| REFERENCE (NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU) |
| 1. NAME:__________________________________________ |
TELEPHONE NUMBER:_____________________________________________ |
| ADDRESS:__________________________________________________________________________________________________________________________ |
| 2. NAME: __________________________________________ |
TELEPHONE NUMBER:_____________________________________________ |
| ADDRESS:__________________________________________________________________________________________________________________________ |
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STATE LAW NOTICES
OHIO RESIDENTS ONLY: the Ohio laws against discrimination require that all make credit equally 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.
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WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign 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. |
| Signature____________________________________ |
Date_________________ |
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TERMS & CONDITIONS
| 1. You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify use in writing immediately You authorize the Credit Union to Obtain credit reports in connection with its application for credit and for any update, increase, renewal, extension or collection of the credit received. You understand that the Credit Union will rely 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. |
2. If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the credit card agreement and disclosures. You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. When you are in default, you authorize us to to apply the balance in these accounts to any amounts due. Shares and deposits in an individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security interest you have given in your share and deposits. |
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| Signature____________________________________ |
Date_________________ |
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Before printing make sure your print margins are set to 0.2"
Look under File menu, Click on Page Setup, then change margins to 0.2" |
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You Must Print, Sign, and Return to Credit Union
by mail (53A Jefferson Parkway, Newman GA, 30263), fax (770-253-4218), or in person
A signature is needed to complete the process.
If this page is printed and faxed to the credit union, please include a copy of a photo ID along with your request.
Before printing make sure your print margins are set to 0.2"
Look under File menu, Click on Page Setup, then change margins to 0.2"
If this page is printed and faxed to the credit union, please
include a copy of a photo I.D. along with your request. |
