ATTENTION: For Home Loans, please see above for Mortgage Application

Credit Type*

Individual Credit - Complete Applicant sections if only the applicant's income is considered for loan approval. Complete Applicant and Co-Applicant sections: (1) if you are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of credit requested, or; (2) if you reside in a Community Property State, or; (3) if you are relying on property located in a Community Property State as a basis for repayment of the creditrequested. Community Property States include: AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI.

Joint Credit - Complete Applicant and Co-Applicant sections if your co-applicant will be contractually liable for repayment of the loan.

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

Loan Type*

Auto Loan

Recreational Vehicle Loan

Signature Loan

Line of Credit

Shared Secure Loan

Credit Builder Loan

Other Loan Request

Please check to indicate the type of account(s) and type of credit for which you are applying.

Please Explain Loan Type

Purpose/Collateral

Amount Requested*

Repayment*

Payroll Deduction

Payment Coupon

Automatic Payment

WebPay

Other

Name*

First Middle Last

Account Number

Social Security #*

Mother's Maiden Name

Email*

Enter Email Confirm Email

Birth Date*

Cell Phone*

Home Phone

Preferred Contact Method

Telephone

Email

Present Address*

Street Address Address Line 2 City State ZIP Code

Have you lived at present address more than 3 years?*

Yes

No

Previous Address

Street Address Address Line 2 City State ZIP Code

Move in Date at Present Address*

Own or Rent?

Rent

Own

Monthly Rent Payment

Purchase Price of the Home

Present Home Value

Monthly Mortgage Payment

Mortgage Balance

Relationship Staus*

MARRIED (WA and CA Only -includes registered domestic partners)

SEPARATED

UNMARRIED (Single, Divorced, Widowed)

Please complete the following, only if you are applying for joint credit, secured credit, or if you live in a community property state:

Name of Employer*

Address of Employer

Street Address Address Line 2 City State ZIP Code

Hire Date*

Position Held*

Prior Employer

Employment Income (GROSS)*

Per (hour, month, year)*

Other Income (GROSS)

PER

Source

Reference Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone Number*

Relationship

Are You Applying With A Co-Applicant?*

Yes

No

OHIO RESIDENTS ONLY

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.

WISCONSIN RESIDENTS

Notice: 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.

MARRIED WISCONSIN RESIDENTS APPLYING FOR AN INDIVIDUAL ACCOUNT

By signing here, I state that the credit being applied for, if granted, will be incurred in the interest of the marriage or family of the Borrower(s).

Wisconsin Residents Marital Status

Married

Unmarried

Legally Seperated

Spouse Name

First Last

Spouse SSN#

Spouse Address

Street Address Address Line 2 City State ZIP Code

All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on this application. You have my permission to check it. You may retain this application even if not approved. I understand that you may receive information from others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. If this application is approved, I agree to honor the provisions of the credit or loan agreement and security agreement covering my account or loan. (If this application is for two of us, this statement applies to both of us.)

Credit Report Authorization. By submitting this Application, I authorize you to obtain my credit report for the purposes of evaluating this application and to obtain subsequent credit reports on an on-going basis in connection with this transaction, and for all other legitimate purposes, such as reviewing my accounts or taking collection action on the account.

Vermont Residents: Applicant provided consent via phone _______________ (Credit Union Initials)

IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for me: When I open an account, you will ask for my name, address, date of birth, and other information that will allow you to identify me. You may also ask to see my driver's license or other identifying information.

HAVE YOU OMITTED ANYTHING? REMEMBER: INCOMPLETE APPLICATIONS CANNOT BE PROCESSED

I have read and understand the policy above*

Yes

Signature

This is not required. If you are unable to sign your name, please skip this step.

Once you submit this application, you cannot return to edit your responses.

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Name

This field is for validation purposes and should be left unchanged.

Loan Application

Applying for a Home Loan?

ATTENTION: For Home Loans, please see above for Mortgage Application

OHIO RESIDENTS ONLY

WISCONSIN RESIDENTS

MARRIED WISCONSIN RESIDENTS APPLYING FOR AN INDIVIDUAL ACCOUNT

IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

HAVE YOU OMITTED ANYTHING? REMEMBER: INCOMPLETE APPLICATIONS CANNOT BE PROCESSED

Once you submit this application, you cannot return to edit your responses.

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