Credit Union of Emporia Loan Application

How to Apply:

Individual Credit: You must complete the Applicant section about yourself and the Other 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 Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Check below to indicate the type of account(s) and type of credit, for which you are applying. Married Applicants may apply for a separate account.

LOANLINER® Account/Loan: Individual Joint    Amount Requested $ Purpose/Collateral:

Repayment: Payroll Deduction Cash Military Allotment Automatic Payment

Payment Protection

Single Credit Disability Insurance

Check coverage(s) desired. The credit union will disclose the cost of this voluntary insurance to you. A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.

Applicant

NAME (Last - First - Initial)
 MOTHER'S MAIDEN NAME
 ACCOUNT NUMBER
SOCIAL SECURITY NUMBER
 DRIVER'S LICENSE NUMBER / STATE
 LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT (Exclude Self)
BIRTH DATE
 HOME PHONE
 BUSINESS PHONE/ EXT.
E-MAIL ADDRESS (required)
 PRESENT ADDRESS (Street - City - State - Zip)
 OWN RENT
YEARS AT PRESENT ADDRESS

 PREVIOUS ADDRESS (Street - City - State - Zip)
 OWN RENT
YEARS AT PREVIOUS ADDRESS
 COMPLETE FOR JOINT CREDIT. SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
Employment/Income
NAME AND ADDRESS OF EMPLOYER
 TITLE/GRADE

 START DATE
HOURS AT WORK
 SUPERVISOR'S NAME
 IF SELF EMPLOYED, TYPE OF BUSINESS
NOTICE: ALIMONY. CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
EMPLOYMENT INCOME
 PER
 NET GROSS
OTHER INCOME
 PER
 SOURCE
MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?
YES NO		 WHERE

 ENDING/SEPARATION DATE
PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS
 STARTING DATE
 ENDING DATE

Other:     Co-Applicant Spouse Guarantor

NAME (Last - First - Initial)
 MOTHER'S MAIDEN NAME
 ACCOUNT NUMBER
SOCIAL SECURITY NUMBER
 DRIVER'S LICENSE NUMBER / STATE
 LIST AGES OF DEPENDENTS NOT LISTED BY OTHER APPLICANT (Exclude Self)
BIRTH DATE
 HOME PHONE
 BUSINESS PHONE/ EXT.
E-MAIL ADDRESS
 PRESENT ADDRESS (Street - City - State - Zip)
 OWN RENT
YEARS AT PRESENT ADDRESS

 PREVIOUS ADDRESS (Street - City - State - Zip)
 OWN RENT
YEARS AT PREVIOUS ADDRESS
 COMPLETE FOR JOINT CREDIT. SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
MARRIED SEPARATED UNMARRIED (Single - Divorced - Widowed)
Employment/Income
NAME AND ADDRESS OF EMPLOYER
 TITLE/GRADE

 START DATE
HOURS AT WORK
 SUPERVISOR'S NAME
 IF SELF EMPLOYED, TYPE OF BUSINESS
NOTICE: ALIMONY. CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
EMPLOYMENT INCOME
 PER
 NET GROSS
OTHER INCOME
 PER
 SOURCE
MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR?
YES NO		 WHERE

 ENDING/SEPARATION DATE
PREVIOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN FIVE YEARS
 STARTING DATE
 ENDING DATE

 

Applicant Reference
NAME AND ADDRESS OF NEAREST RELATIVE NOT
LIVING WITH YOU
 RELATIONSHIP
 HOME PHONE
Other Reference
NAME AND ADDRESS OF NEAREST RELATIVE NOT
LIVING WITH YOU
 RELATIONSHIP
 HOME PHONE
What You Owe
RENT FIRST MORTGAGE
(Include Tax and Ins.) 		CREDITOR NAME OTHER THAN THIS CREDIT UNION
INTEREST RATE PRESENT BALANCE MONTHLY PAYMENT OWED BY
APPLICANT OTHER
2nd MORTGAGE
1st AUTO LOAN
2nd AUTO LOAN
CHILD-CARE
CHILD SUPPORT
CREDIT CARD
CREDIT CARD
OTHER
OTHER
LIST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED:
TOTALS    
What You Own
HOME LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION
MARKET VALUE PLEDGED AS COLLATERAL
FOR ANOTHER LOAN		 OWED BY
APPLICANT OTHER
YES NO
AUTO
YES NO
SAVINGS
YES NO
CHECKING
YES NO
OTHER (Describe)
YES NO
Other Information About You
1. ARE YOU A U.S.CITIZEN OR PERMANENT RESIDENT ALIEN?
APPLICANT
YES NO
OTHER
YES NO
2. DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT?
YES NO
YES NO
3. IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?
YES NO
YES NO
4. ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE?
FOR WHOM (Name of Others Obligated on Loan):
YES NO
YES NO
State Law Notices

OHIO RESIDENTS ONLY: 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.

WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree,or has actual knowledge of its terms, before the credit is granted or the account is opened.(2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

SIGNATURE FOR WISCONSIN RESIDENTS ONLY DATE

You 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 what you owe. If there are any important changes you will notify us immediately. 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. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA.

APPLICANT'S SIGNATURE (Type your full name) DATE OTHER SIGNATURE (Type your full name) DATE