You can either type in the blocked areas, print and sign or print and fill each blocked area by hand.
 

Credit Application

  

Check Appropriate Box

  If you are applying for individual credit in your name, not in you own name, are not married, and are not relying on alimony, child support, or separate maintenance payment or on income or assets of another person as the basis for repayment of the credit requested, complete only Sections A and D.  If the requested credit is to be secured, also complete Section E.

  In all other situations, complete all Sections except E, providing information in B about your spouse, a joint applicant or user, or the person on whose alimony, support, or maintenance payments of income or assets you are relying.  If the requested credits is to be secured, also complete Section E.

We intend to apply for joint credit.                                                                                                                                                                                                 Applicant                                                       Co-Applicant

 

Amount Requested        Payment Date Desired           Proceeds of Credit     

$               To be Used For

 

SECTION A - INFORMATION REGARDING APPLICANT

Full Name (Last, First, Middle):

Present Street Address:

City: State: Zip: Telephone:

Social Security Number:      Driver's License Number:

Previous Street Address:   Years There:

City: State: Zip:

Present Employer: Years There: Telephone:

Position or Title:      Name of Supervisor:

Employer's Address:

Present net salary or commission: $ per: Number of Dependents: Ages: 

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.  

Alimony, child support, separate maintenance received under: court order written agreement oral understanding

Other income: $ per: Source (s) of other income:

Is any income listed in this Section likely to reduced in the next two years?

Yes (Explain in detail on separate sheet.)  No

Complete the following only if you reside in a community property state (Arizona, California, Idaho, Louisiana, New Mexico, Nevada, Texas, Washington or Wisconsin): Married   Separated   Unmarried

Have you ever received credit from us? When? Office:

Share Draft Account Number: Institution and Branch:

Shares Account Number:    Institution and Branch:

Name of nearest relative not living with you: Telephone:

Relationship:   Address:

 

SECTION B - INFORMATION REGARDING JOINT APPLICANT, USER, OR OTHER PARTY                                   (Use separate sheets if necessary)

Full Name (Last, First, Middle):

Present Street Address:

City: State: Zip: Telephone:

Social Security Number:      Driver's License Number:

Previous Street Address:   Years There:

City: State: Zip:

Present Employer: Years There: Telephone:

Position or Title:      Name of Supervisor:

Employer's Address:

Present net salary or commission: $ per: Number of Dependents: Ages: 

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.  

Alimony, child support, separate maintenance received under: court order written agreement oral understanding

Other income: $ per: Source (s) of other income:

Is any income listed in this Section likely to reduced in the next two years?

Yes (Explain in detail on separate sheet.)  No

Complete the following only if you reside in a community property state (Arizona, California, Idaho, Louisiana, New Mexico, Nevada, Texas, Washington or Wisconsin): Married   Separated   Unmarried

Share Draft Account Number: Institution and Branch:

Shares Account Number:    Institution and Branch:

Name of nearest relative not living with you: Telephone:

Relationship:   Address:

 

SECTION C - MARITAL STATUS

Applicant: Married Separated Unmarried (including single, divorce, and widowed)

Other party: Married Separated Unmarried (including single, divorce, and widowed)

 

SECTION D - ASSET AND DEBT INFORMATION (If section B has been completed, this section should be completed giving information about both the Applicant an Spouse, Joint Applicant, User, or Other Person.  Please mark Applicant-related with an " A."  If Section B was not completed, only give information about the Applicant in this Section.)

ASSETS OWNED (use separate sheet if necessary.)

 Description of Assets 

Value 

  Subject to Debt?(Yes/No)

  Name (s) of Owner (s)

  Cash 

 $

                 Automobile (Make, Model, Year)                

  

 $

Cash Value of Life Insurance (Issuer Face Value)

  $

 Real Estate (Location, Date Acquired)

  $

 Marketable Securities (Issuer, Type, No. of Shares)

  $

Other (List)

 

 

 $

$

$

Total Assets

 $    

                                                                                                                                      

OUTSTANDING DEBTS (Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. use separate sheet if necessary.

Creditor

Type of Debt or Acct. No.  

Name in Which Acct. Carried

Original Debt

Present Balance

 Monthly Payments

Past Due? Yes/No
1. (Landlord or Mortgage Holder)

 

 Rent Payment

Mortgage

 
2.
3.

Total Debts

     $ $ $  

   

(Credit References)                                                                                                                Date Paid

1.  $

2.  $

Are you a co-maker, endorser, or guarantor on any loan or contract? Yes No                                                                                                      

If  "yes" for whom   To whom?

Are there any unsatisfied judgments against you?  Yes No                                                                                  

 Amount $    If "yes" to whom owned?

Have you been declared bankrupt  in the last 14 years?   Yes         No                  

If  "yes" where?

Other Obligations - (E.g., liability to pay alimony, child support, separate maintenance.  Use separate sheet if necessary.)

SECTION E - SECURED CREDIT (Complete only if credit is to be secured.) Briefly describe the property to be given as security.

and list names and addresses of all co-owners of the property:

Name    Address

Name    Address

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved.  You are authorized to check my credit and employment history and to answer questions about our credit experience with me.

                                                                                                                                                                                                               

                        Applicant's Signature                    Date                                Other Signature                                      Date

                                                                                                                        (Where Applicable)

THIS SECTION FOR OFFICE USE ONLY

 

Name                                                                                      Date                      Account Number                                                

                                                                              $                                                                                           $                          

         Check Made Payable To:                                 Amount              Check Made Payable To:                     Amount

 

Total Loan $                              If Renewal, Amt. Wanted $                          

Terms                                                                                                                                                                                                

Purpose of Loan:                                                                                                                                                                                

Auto Finance:                 

S.P.                                

Trade                            

Cash                           

Dealer                                                                           

Insurance                                                                        

O.B.                                                                            

Share Bal. $                Loan Bal.                     Xmas                    Total                            

Names of Co-maker (s), Guarantors (s)                                                                                                        

                                                                                                                                                                           

Share Balance $                             Loan Balance $                              (1)                                

                          $                                                      $                              (2)                                

Collateral                                                                                                                                 

Credit Union Number                                                   Shift                       Loan Value                               Total                            

                                                                                                Registration

                                                                                                Verified by                                                      Yes         No            

Remarks:                                                                                                                                                                                                                    

Information below, including appropriate signature (s) is to be filled in by either the credit committee or loan officer, depending upon who acts upon this application.

On                                                                                                       (I) (We) approved a loan in the amount and on the conditions requested by the above applicant, except as follows (list any changes in amount, terms or conditions):                                                                                                                                                                                                                

                                                                                                                                                                                                               

Approved by CREDIT COMMITTEE

                                                                                                                                                                                                                

                                                                                                                                                                                                                

                                                                                                                                                                                                                

Approved by LOAN OFFICER:                                                                                                    

(All committee members shown as present in the minutes of the meeting at which this application was approved should sign above.)

If application is rejected - reason for rejection