CREDIT APPLICATION    

Amount Requested $

Purpose

Married Applicants may apply for a separate account.  Check the appropriate box to indicate Individual Credit or Joint Credit.

   Individual Credit:  Complete Applicant Section

   Joint Credit:  Provide information about both of you by completing Applicant and Other section.

APPLICANT

Name

Street Address

City, State, Zip

For your residence, do you   Own        or   Rent      ?

Monthly payment (or rent) amount? 

How long?  

Social Security Number 

Birthdate 

Drivers License Number          

Home Phone 

Employer 

Title/Position               

Date Started 

Years in the same field of work? 

Married     Single  Number of Dependents

NOTICE:  Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.

Net Wages per Month 

Other Income per Month Source

Name and Address of Nearest Relative Not Living With You

Name

Address

Phone 

Answer the following questions:

Do you have any outstanding judgments? Yes    No

Have you had property foreclosed upon or repossessed in the last 7 year?   Yes   No

Are you a party in a lawsuit?  Yes   No

Are you other than a US Citizen?  Yes    No

Have you ever filed for Bankruptcy or had a Debt Adjustment Plan confirmed under Chapter  13?  Yes     No

Complete this section if  

   1) you live in a community property state (AZ,CA,ID,LA,NM,NV,TX,WA,WI) or

   2)  your spouse will use the account or 

   3)  there is a guarantor on this account.

Please CLICK button to indicate whom the information is about

  CO-APPLICANT   SPOUSE   GUARANTOR

Name

Please enter address if different from above applicant:

Street Address

City, State, Zip

For your residence, do you   Own        or   Rent      ?

Monthly payment (or rent) amount? 

How long?

Social Security Number 

Birthdate

Drivers License Number          

Home Phone 

Employer 

Title/Position               

Date Started 

Years in the same field of work? 

Married      Single  Number of Dependents

NOTICE:  Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.

Net Wages per Month 

Other Income per Month Source

Name and Address of Nearest Relative Not Living With You

Name 

Address

Phone

Answer the following questions:

Do you have any outstanding judgments? Yes    No

Have you had property foreclosed upon or repossessed in the last 7 years?   Yes   No

Are you a party in a lawsuit?  Yes   No

Are you other than a US Citizen?  Yes    No

Have you ever filed for Bankruptcy or had a Debt Adjustment Plan confirmed under Chapter  13?  Yes     No

Are you interested in having your loan protected?   Yes     No

If you answer “yes”, the credit union will disclose the cost to protect your loan. The credit insurance is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.

EXPENSE                    Present Balance        Monthly Payment

Car Payment                $      $

Car or RV Payment      $      $

Credit Card                  $      $

Credit Card                  $      $

Credit Card                  $      $

Other     Child Support Credit Card Rental House Payment Vacation Home Payment            $

 Other     Child Support Credit Card Rental House Payment Vacation Home Payment            $  

Are you a co-maker, co-signer or guarantor on any loan not listed above?   No     Yes                                                                To whom? 

List Home, Autos, and Other Assets You Own

Home Market Value 

Auto Market Value 

Name of Financial Institution where you have your checking account -

This information about the costs of the card described in this application is accurate as of 04/01/2010.  The information may have changed after that date.  To find out what may have changed, write or call the credit union.

For Credit Card tips from the Federal Reserve Board  :      

To learn more about factors to consider when applying for or using a credit card, visit the Web site of the  Federal Reserve Board at http://www.federalreserve.gov/creditcard                      

If there are any important changes, you will notify us in writing immediately.  You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter.  You also promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of all your debts and obligations.  You authorize the credit union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received.  If you request, we will tell you the name and address of any credit bureau from which we received a credit report on you.  You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to State Chartered Credit Unions insured by the National Credit Union Administration.

Applicant's Signature                                           Date

Other Applicant's Signature                                 Date

E-mail address (required)