Loan Application

Member Information Title First Name MI Last Name Suffix   Mr. Mrs. Ms. Miss Dr.         II III IV Jr. Sr.   Credit Union Member Number   Social Security Number (Format: 999-99-9999) Loan Information Type of Loan -- select -- Auto Refinance-61-72 monthsAuto Refinance-73-84 monthsAuto Refinance-up to 48 monthsAuto Refinance-up to 60 monthsBoat/Trailer/RV - 37 to 48 mo.Boat/Trailer/RV - 49 to 60 mo.Boat/Trailer/RV - 61 to 72 mo.Boat/Trailer/RV - 73 to 144 moBoat/Trailer/RV - up to 36 mo.New/Used Auto - 49 to 60 mo.New/Used Auto - 61 to 72 mo.New/Used Auto - 73 to 84 mo.New/Used Auto - up to 48 mo.Personal ComputerSignature - 25 to 60 mo.Signature - up to 24 mo. Loan Amount/Credit Limit Requested $ .00 Number of Monthly Payments (Not needed for credit card or Line of Credit)   Type of Credit Individual Joint Relationship of co-applicant to primary applicant (if applying for Joint Credit)   Spouse Parent Child Domestic Partner Other Family Member Other Marital Status Unmarried Married Separated 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: 1.  You live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI), 2.  Your spouse will use the account, or 3.  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. Payment Protection Coverage Find out more about Payment Protection Insurance and why it's a better consumer value when offered through your credit union. Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective. Do you want your loan 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 your death?  Yes No