Creditor Address and Account #	Date Loan	Original Debt	Present Balance	Monthly Payment	Past Due?
Rent
Mortgage
Auto Loan
Credit Union
Credit Card
Credit Card
Alimony, etc.
Thrift Fund Loan
Other
Attach another sheet if necessary
TOTALS

Home: Own Rent

Years There:_____________

Est. Market Value:___________________

Make of Auto____________________________

Year____________________________________

Are there any other persons obligated on any of the above loans?

No

Yes

Which ones and Who?______________________________________________________________

Are you a co-maker, co-signer, or guarantor on any loan?

No

Yes

For whom?______________________________

To whom?_______________________________

Have you been declared bankrupt in the last 14 years?

No

Yes

Everything that I have stated in this application is correct to the best of my knowledge. You are authorized to check my credit and employment history and to ask questions about my credit experience with me.

Signature of Member______________________________________________

Date___________________

Credit Committee and Loan Officer Action

Loan Officer:

I approve the loan as submitted

Loan referred to Credit Committee

Reason___________________________________________

Loan Officer Signature______________________________________

Date___________________

Credit Committee:

We approve the loan as submitted.

We reject the loan as submitted.

The following counter offer will be made to the applicant and if accepted, we approve the loan.

Describe_________________________________________________________________________

Specific reasons for rejection__________________________________________________________

Outside information considered?

No

Yes

Describe________________________________

Signed___________________________________	Date___________________
Signed___________________________________	Date___________________
Signed___________________________________	Date___________________