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Loan Application

Upon submission of this loan application you agree to pay a $5 application fee. This fee will be deducted from the account that you select prior to submitting this application and the following on the bottom.
* indicates a required field

1. Loan Information
1.1 - Account Number - Applicant:
1.2 - Desired loan amount: $ *
1.3 - Types of Loan:
1.4 - Purpose of Loan
1.5 - If required will you provide collateral to secure this loan?
   1.5a - If yes please describe collateral:
(ie.,yr, make, model)

2. Primary Applicant
2.1 - Name:
First: * Middle: Last: * Suffix:
2.2 - Social Security Number: *

555-55-5555
  2.3 - Date of birth: *

mm/dd/yy
2.4 - What is your e-mail address? *
(Re-enter your e-mail address)
2.5 - Phone Number: *
555-555-5555
2.6 - What is your home address? *
Street: City: State: Zip:
2.7 - Rent|Own|Parsonage: *
   2.7a - Monthly Payment Amount: *
2.8 - Time at residence:
2.9 - Previous address (if less than 3 years at current residence):
Street: City: State: Zip: Years There:
2.10 - Current employer: *
2.11 - Title or position:
2.12 - Are you self employed?
2.13 - Business phone number:
ext.
555-555-5555
2.14 - Date Started Position:
mm/dd/yy
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
2.15 - Salary: * $ .00 - Monthly
2.16 - Other income: $ .00 - Monthly
   2.16a - Source of income:
   2.16b - Payer of income:
2.17 - Previous Employer:
2.18 - Position at Previous Employment:
2.19 - Years at Previous Employment:
2.20 - Other Information:
    2.20a  - 
Have You had any foreclosure or lost title deed (repossession) on property in the past 7 years?
Yes No
    2.20b  - 
Have you filed for bankruptcy in the past 7 years?
Yes No
    2.20c  - 
Are there currently any outstanding judgments against You?
Yes No
    2.20d  - 
Are You other than a US citizen or permanent resident alien?
Yes No
    2.20e  - 
Are You a party to any lawsuit?
Yes No
    2.20f  - 
Is Your income likely to decline within the next 2 years?
Yes No
    2.20g  - 
Are You a Co-Maker/Endorser on any loan?
Yes No
    2.20h  - 
Are You required to pay any alimony, child support or other support payments?
Yes No
    2.20i  - 
If 2.20h is yes, what is the ammount?
If Applying For An Individual Loan Click Here

3. Joint Applicant
3.1 - Joint Applicant Type:   
3.2 - Name:
First: Middle: Last: Suffix:
3.3 - Social Security Number:

555-55-5555
3.4 - Date of birth:

mm/dd/yy
3.5 - What is your e-mail address?
(Re-enter your e-mail address)
3.6 - Home Phone Number:
555-555-5555
3.7 - What is your home address?
Street: City: State: Zip:
3.8 - Rent|Own|Parsonage:
    3.8a - Montly Payment Amount:
3.9 - Time at residence:
3.10 - Previous address (if less than 3 years at current residence):
Street: City: State: Zip: Years There:
3.11 - Current employer:
3.12 - Title or position:
3.13 - Are you self employed?
   3.13a - Type of Business:
3.14 - Business phone number:
ext.
555-555-5555
3.15 - Date Started Position:
mm/dd/yy
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
3.16 - Salary: $ .00 - Monthly
3.17 - Other income: $ .00 - Monthly
   3.17a - Source of income:
   3.17b - Payer of income:
3.18 - Previous Employer:
3.19 - Position at Previous Employment:
3.20 - Years at Previous Employment:
3.21 - Other Information:
    3.21a  - 
Have You had any foreclosure or lost title deed (repossession) on property in the past 7 years?
Yes No
    3.21b  - 
Have you filed for bankruptcy in the past 7 years?
Yes No
    3.21c  - 
Are there currently any outstanding judgments against You?
Yes No
    3.21d  - 
Are You other than a US citizen or permanent resident alien?
Yes No
    3.21e  - 
Are You a party to any lawsuit?
Yes No
    3.21f  - 
Is Your income likely to decline within the next 2 years?
Yes No
    3.21g  - 
Are You a Co-Maker/Endorser on any loan?
Yes No
    3.21h  - 
Are You required to pay any alimony, child support or other support payments?
Yes No
    3.21i  - 
If 3.21h is yes, what is the ammount?

4. Other Information
4.1 Other Information:


By submitting this application, you warrant the truth of the above information and You realize that it will be relied upon by the Credit Union in deciding whether or not to grant the credit applied for. You hereby authorize the Credit Union, its employees and agents to investigate and verify any information provided to the Credit Union by you. You agree and understand that if approved, you are contractually liable according to the applicable terms of the Loan Agreement and Consumer Credit Disclosure Statement (Agreement). You will receive a copy of the Agreement no later than the time of your first credit advance and you promise to pay all amounts charged to your account according to its terms. If this is a joint application, you agree that such liability is joint and several. You authorize us to accept your facsimile signatures or electronic signatures on this application and agree that your facsimile signature and/or electronic signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile and/or electronic signature.
The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Upon submission of this loan application, you agree to pay a $5 application fee. As the applicant, you are authorizing the Credit Union to deduct the $5 loan application fee from your:
Checking     Savings account.