Loan Application
Enter Loan Information
E-mail address:
Name: Acct. Number
Street/PO Box: Home Phone:
City: State: Work Phone:
Zip:      

I hereby apply for a loan of $ for a period of months
for the purpose of .
Collateral: or Co-maker:
Employer: Position:
Employer's Address: Date Employed:
Monthly Income (net): $ Are you paid over 10 months or 12 months?
Other Income (do not include alimony or child support unless you wish C.U. to consider such income in connection with this loan application): $
Have you ever been through bankruptcy? no yes Date
Have you any judgements, garnishments or legal proceedings against you? no yes
If yes, fully explain:
Date of Birth: / / Length of time at present address:
Autos owned:
Make/model
Year Mileage
2nd auto:
Make/model
Year Mileage
Personal Reference (not spouse): Acct. Number
Street/PO Box: Phone:
City: State: Zip:  
I hereby certify that the above information is true and correct. I understand that you will retain this application whether or not it is approved. You are authorized to check credit and employment history.
List all of your creditors including rent, credit cards, mortgage payments, auto loans, doctor bills, installment loans. Check any obligations which you will pay with the proceeds of this loan.
To whom owed Purpose Pay with this loan? Original Amount Current Balance Monthly Payment
TOTALS    
**Reasonable market value of real estate $ at
Bank reference: Checking or Savings

Complete if applicable
Co-maker's Name:    
Street/PO Box: Phone:
City: State: Zip:  
Relationship to applicant: Spouse Parent Other (specify)
Employer: Position:
Employer's Address: Date Employed:
Monthly Income (net): $ Other Income: $