Please Tell Us About Yourself (Primary Borrower)

Address (Primary Borrower)

Contact Information (Primary Borrower)

Assets (Primary Borrower)

Your Vehicles

Vehicle 1

Vehicle 2

Employment Information (Primary Borrower)

If you have been with your current employer less than two years, please provide information on your previous employer.

Other Income: Monthly dollar amount that you recieve in alimony, child support, or separate maintenance - this income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Relatives (Primary Borrower)

Please list two of your nearest relatives who are not living with you.

Statement of Total Indebtedness and Liabilities
(Primary Borrower)

Mortgage or Rent

Auto 1

Auto 2

Credit Union

Bank

Credit Card 1

Credit Card 2

Other

Child Support / Alimony / Separate Maintenance

Please tell us about yourself (Secondary Borrower)

Address (Secondary Borrower)

If the Secondary Borrower's address is not the same as the Primary Borrower's, please fill in the address information below.

If the Secondary Borrower has been at the current address for less than 2 years, and if the Secondary Borrower's previous address is different from the Primary Borrower's please provide information about the Secondary Borrower's previous residence.

Contact Information (Secondary Borrower)

Assets (Secondary Borrower)

Vehicles

Vehicle 2

Employment Information (Secondary Borrower)

If the Secondary borrower has been with the current employer for less than 2 years please provide information on the Secondary Borrower's previous employer.

Other Income: Monthly dollar amount that the Secondary Borrower recieves in alimony, child support, or separate maintenance - this income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Relatives (Secondary Borrower)

Please list two of your nearest relatives who are not living with you.

Statement of Total Indebtedness
(Secondary Borrower)

Mortgage or Rent

Auto Loan 1

Auto Loan 2

Credit Union

Bank

Credit Card 1

Credit Card 2

Other

Child Support / Alimony / Separate Maintenance

Click the "I accept the terms of the disclaimer above and submit my application" button to send the application to us via the Internet after reading the disclaimer below.  By clicking "I accept the terms of the disclaimer above and submit my application", you accept the terms of the disclaimer below.

DISCLAIMER:  I/WE HEREBY CERTIFY THAT ALL STATEMENTS MADE ARE TRUE AND COMPLETE, ARE SUBMITTED FOR THE PURPOSE OF OBTAINING CREDIT, AND THAT THE CREDIT UNION MAY RELY ON THEM FOR SUCH DETERMINATION.  I/WE AUTHORIZE YOU TO OBTAIN SUCH INFORMATION AS YOU MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION, AND AGREE THAT THE APPLICATION SHALL REMAIN YOUR PROPERTY, AND YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME/US.

Applicant Signature: _____________________________________________
Date: ____________________

Co-applicant Signature: __________________________________________
Date: ____________________