Application

SECURE LOAN APPLICATION

	Amount of Loan	$	*
	Purpose of Loan		*
	If Signature, Purpose
	Type of Loan
	Member Number		*
	Applying for
	Length of Repayment		Months

If your purpose is for vehicle and you are buying from a dealer:

	Dealer's Name
	Purchase Price	$
	Make & Model
	Miles
	Year

Important notice: Income from alimony, child support or separate maintenance need not be revealed if you do not choose to rely upon such income in applying for credit.
SOME INFORMATION ABOUT YOU (Applicant)

	First Name		*
	Middle Name
	Last Name		*
	Phone		*
	Email		*

Present Address

	Street		*
	City		*
	State		*
	Zip		*
	Time at Residence		Years*

Your Present Employer

	Employer's Name		*
	Phone		*
	Position		*
	How Long?		Years*

Your Assets

	Auto Make & Model

ARE YOU APPLYING WITH ANOTHER PERSON? (Co-Applicant for joint credit) If not, you may skip down to "Applicant's Monthly Income"

	Name (first, middle, last)
	Phone
	Social Security Number
	Date of Birth
	Relationship to Applicant

Co-Applicant's Address

	Street
	City
	State
	Zip

Co-Applicant's Present Employer

	Employer's Name
	Phone
	Position
	How Long?		Years

Applicant's Monthly Income

	Gross Monthly Income (Before taxes)	$	*
	Social Security Income	$
	Pension	$
	Other (Please enter the amount and explain)
	Total Income	$

Co-Applicant's Monthly Income

	Gross Monthly Income (Before taxes)	$	*
	Social Security Income	$
	Pension	$
	Other (Please enter the amount and explain)
	Total Income	$

Notice: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy 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.

Credit Information Outstanding - List all Debts (i.e. Car Loans, Bank Loans, Finance Companies, Credit Unions, Department Stores, Credit Card Accounts, etc.)

Applicant's Debts
	Name of Creditor		Monthly Payment		Balance Owed

	Mortgage Rent Live At Home	$		$
	Alimony/Child Support	$		$

Co-Applicant's Debts
	Name of Creditor		Monthly Payment		Balance Owed

	Mortgage Rent Live At Home	$		$
	Alimony/Child Support	$		$


Comments or Questions:


Member: I Hereby Attest that the Above Information Is True
Co-Applicant: I Hereby Attest that the Above Information Is True

How would you like us to contact you?
If telephone, what is your daytime number?

Local 219 Federal Credit Union Secure Loan Application. Copyright © 2003 [Local 219 Federal Credit Union]. All rights reserved.

Local 219 Federal Credit Union Secure Loan Application.
Copyright © 2003 [Local 219 Federal Credit Union]. All rights reserved.