Application
must be filled out completely, front and back. Date_______________________
Information regarding:
Applicant
Additional party
Name_________________________
Account #______________________________________________
I / We hereby apply
for a loan as follows: (to be completed by applicant)
Amount of money as requested............$___________________________________________________
Old Loan Balance (if any).....................$___________________________________________________
Total New Loan...………………….........$____________________________________________________
To be repaid in_________ payments of $____________________________________________________
Purpose of Loan________________________________________________________________________
Individual
Credit: (do NOT complete marital status for INDIVIDUAL credit in non-community
property state)
Applicant's
Signature Only_______________________________________________________
Endorser, guarantor,
or Co-signer (Name )__________________________________________
Joint Credit-Joint
Applicant or Co-maker (person who will be equally liable for repayment)
Name___________________________________________________________________________
(have
this person complete a separate loan application)
Relationship to Applicant,
if any______________________________________________________
Secured Credit-Collateral
Shares in Account # ________________________ $
____________________________________
New/Used Auto-Make________________________Year__________Cost/Value$______________
Other :__________________________________________________________________________
Owner's Names : _________________________________________________________________ Marital Status: Complete
marital status if this loan is for a. joint or secured credit, or
b. You reside in or rely on property located in a Community Property State(AZ,
CA, ID, LA, NM,NV,TX, WA, WI)
Unmarried
Married
Separated
Full Name__________________
Birth Date________________ Social Security # __________________
Drivers Lic.#________________ Street Address_________________ Yrs. There ___________________
City_____________________________ State_____________________ Zipcode ___________________
Home Ph: ___________________Bus. Ph.:______________ Present Employer:___________________
Yrs. There_________ Pos./Title:_______________________ Work Location:______________________
Employers' Address_________________________________Supervisor___________________________
City_____________________________ State____________________ Zipcode_____________________
Dependents (exclude self) Ages __________________________________________________________
Name of nearest relative not living with you_______________________ Relationship________________
Address _____________________________________________________________________________
Check One: Pay Period: Bi-weekly
Semi-Monthly
*(Alimony, Child Support or separate maintenance income need
not be revealed if you do not wish to have it considered as a basis fo repaying
this loan)
Salary Gross $______________________ per year
Other income $______________________ per _________ source_______________________________
Is any income listed likely to be reduced before this loan is paid off?
No
Yes
If yes, please explain____________________________________________________________________
Share Draft or Checking Account #_______________________ Where__________________________
Share or Savings Account #______________________________Where__________________________
Previous Address (if at current
address less than 2 years)______________________________________
Prev. Street Address______________________________________________ Yrs. There_____________
City______________________________ State_______________ Zipcode_________________________
Previous Employer (if less than 2 years with current employer)__________________________________
Previous Employer________________________________________________ Yrs. There____________
Previous Employer's Address____________________________________________________________
(continue to next page)