Loan Application Page

ABOUT SSL CERTIFICATES

Please complete and submit the following form to apply for a loan application.

We will be happy to contact you regarding your request. Include a daytime phone number or e-mail address where you can be contacted.

Upon approval you will be required to submit a recent pay stub before the loan can be disbursed.

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:

You live in or the property pledged as collateral is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI),
Your spouse will use the account, or
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 Co-Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections. If you are a Wisconsin resident and are applying for Joint Credit with someone other than your spouse, each of you should complete the Applicant section of separate applications. If either or both of you are married, you must also provide information about your spouse and complete the Signature area at the end of this application.

PAYMENT PROTECTION COVERAGE Click if desired

Check coverage (s) desired. We will disclose the cost of this Payment Protection Insurance Single Credit Disability, Single Credit Life, or Joint Credit Life to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Yes No

Do you want your payments protected for you and your family if you become disabled?

Yes No

Do you want your loan protected for you and your family in the event of death for you or your co-borrower?

Loan Type: Term:

Account Number
Amount Requested
This application initiates the loan process. Final signature (s) will be required to advance funds.
PLEASE TELL US ABOUT YOURSELF (PRIMARY BORROWER)
Full Name
Home Address
Years at Residence
Home Phone
Daytime Phone
E-mail Address
Driver's License State
Driver's License Number
Social Security Number
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:		Married Separated Unmarried (Single - Divorced - Widowed)
Birth Date
PLEASE TELL US ABOUT YOUR JOB (PRIMARY BORROWER)
Current Employer
Years of employment
Phone Number
Position
Gross Monthly Income
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source
The following information pertains to CO-BORROWER. If there is not a CO-BORROWER, click here to continue.
PLEASE TELL US ABOUT YOURSELF (CO-BORROWER)
Full Name
Home Address
Years at Residence
Home Phone
Driver's License State
Driver's License Number
Social Security Number
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:		Married Separated Unmarried (Single - Divorced - Widowed)
Birth Date
PLEASE TELL US ABOUT YOUR JOB (CO-BORROWER)
Current Employer
Years of employment
Phone Number
Position
Gross Monthly Income
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source
Are you a Co-Borrower on any other loans?		Yes No
If Yes Please Explain:
PLEASE LIST TWO NEAREST RELATIVES NOT LIVING WITH YOU
Full Name
Home Address
Phone Number

Full Name
Home Address
Phone Number
CURRENT CREDIT OBLIGATIONS
OWED TO:	Name of Creditor	Current Balance	Monthly Payment	Estimated value
Mortgage Rent
AUTO:
AUTO:
Credit Card:
Credit Card:
Home Equity/Overdraft:
Other:
Other:
$ Amount you pay in alimony or child support
Are you a Co-signer/Guarantor on any loans?		Yes No
For Whom:		Where:	Monthly Payment:

NOTICE TO WISCONSIN RESIDENTS: No provision of any marital property agreement, unilateral statement under S.766.59, or court decree under S.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.

If you are applying for this account or loan with someone other than your spouse, you agree by signing below that the credit applied for, if granted, will be incurred in the interest of the marriage or family. ____________________ Borrower Signature and Date

Click the Submit Application button to send the application to us via the WWW. Use an additional E-mail if you need to give us any further information. Please put your full name in the email.

SIGNATURES: You promise 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 change in your name, address or employment within a reasonable 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.

By submitting this loan request, you agree that the information is correct to the best of your knowledge and to all terms defined in the disclosure information. You also agree to notify us of any changes to your name, address or employment.

X________________________________
Applicant Signature and Date

X________________________________
Co-Applicant Signature and Date