Please complete all sections and return to your credit union by clicking "Submit" at the end of this form. Incomplete forms may delay processing. A credit union representative will contact you regarding your loan application status.     Section 1: TYPE OF CREDIT (choose one) Individual Credit: Complete "Applicant" section. (below) Also complete "Co-Applicant/Spouse" section (at right) 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. Joint Credit: Complete "Applicant" section (below) and "Co-Applicant/Spouse" section (at right) . Amount Requested $ Purpose Collateral: Repayment: Payroll Deduction Cash Automatic Payment Military Allotment Section 2: APPLICANT INFORMATION APPLICANT Name Email address Driver's License # State Account # SS # Date of Birth Home Phone Work Phone Address City State Zip Own Rent Years at this address Married Separated Unmarried (Single-Divorced-Widowed) List ages of dependents not listed by other applicant (exclude self) CO-APPLICANT/SPOUSE Name Email address Driver's License # State Account # SS # Date of Birth Home Phone Work Phone Address City State Zip Own Rent Years at this address Married Separated Unmarried (Single-Divorced-Widowed) List ages of dependents not listed by other applicant (exclude self) Employment Information: Employer Employer address City State Zip Title Supervisor Start Date Gross Monthly Income Employment Information: Employer Employer address City State Zip Title Supervisor Start Date Gross Monthly Income References: List name, full address and phone number of 1) Creditor to whom debts have been paid off, 2) Nearest relative not living with you, 3) Personal reference References: List name, full address and phone number of 1) Creditor to whom debts have been paid off, 2) Nearest relative not living with you, 3) Personal reference Assets: List value (in dollars) of all assets. Include checking and savings accounts, stocks, bonds and all property and goods owned. Assets: List value (in dollars) of all assets. Include checking and savings accounts, stocks, bonds and all property and goods owned. Debts: List value (in dollars) of all current debts owed. For example: auto loans, credit cards, mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc. Please use a separate line for each credit card and auto loan. Debts: List value (in dollars) of all current debts owed. For example: auto loans, credit cards, mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc. Please use a separate line for each credit card and auto loan. I/we certify that statements made on this application are correct to the best of my/our knowledge and that the above information is a complete listing of all our debts and obligations. I authorize the credit union to obtain credit reports in connection with this application. 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. If there are any immediate changes, I/we will notify the credit union in writing immediately. I/we also agree to notify the credit union of any change in name, address or employment within a reasonable time.