Loan Application Loan Information Type of Loan Amount Requested Choose One New Car Used Car Motorcycle Recreational Vehicle Boat Unsecured Share Secured Line of Credit $ General Information Will there be a co-applicant on this application yesno Marital Status: Complete marital status if this loan is for: a. Joint or secured credit, or b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI) UnmarriedMarriedSeparatedThis application is not for joint or secured credit and I do not live in the states listed above. Primary Applicant Personal Information Member Number SSN (TIN) DOB (mm/dd/yy) Last Name First Name Middle Name Street City State Zip Home Phone Work Phone Cell Phone () -Second partThird part () -Second partThird part () -Second partThird part Email Address Age of Dependents Type of Residence OwnRentOther Time at Current Residence Years Months Monthly Payment 1 2 3 4 5 6 7 8 9 10 11 $ Other Income Source $ Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Primary Applicant Employment/Income Employer Name Phone Number () -Second partThird part Job Title Job Start Date (mm/dd/yy) Gross Salary Per $ Year Month Weekly Hour Other Income Per $ Year Month Co-Applicant Personal Information Member Number SSN (TIN) DOB (mm/dd/yy) Last Name First Name Middle Name Street City State Zip Home Phone Work Phone Cell Phone () -Second partThird part () -Second partThird part () -Second partThird part Email Address Age of Dependents Type of Residence Other OwnRentOther Time at Current Residence Years Months Monthly Payment 1 2 3 4 5 6 7 8 9 10 11 $ Other Income Source $ Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Co-Applicant Employment/Income Employer Name Phone () -Second partThird part Job Title Job Start Date (mm/dd/yy) Gross Salary Per $ Year Month Weekly Hour Other Income Per $ Year Month Please list other liabilities For example: home association dues, alimony, child support, child care, auto insurance, tax liabilities, etc. If you need additional room, please use the "Special Instructions/Comments" section. Obligation Monthly Payments $ $ $ $ Additional Information How would you prefer to be contacted? Other HomeWork PhoneEmailOther Special Instructions/Comments Income verification and other information may be required 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. Wisconsin residents only: please type your name Signatures You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes, you will notify us in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and for any update, increase, renewal, extension, or collection 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 You have received and read the LOANLINER Credit and Security Agreement, including the Addendum (“Agreement”) and a Credit Insurance Certificate. By signing below you agree to be bound by the terms of the Agreement. If you are applying for a credit card you understand that use of your credit card will constitute acknowledgment of receipt and agreement to the terms of the credit card agreement and disclosures. You grant us a security interest in all-individual and joint share and/or deposit accounts you have with us now and in the future to secure what you owe under the Agreement and if you have applied for a credit card, under the credit card agreement. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. Shares and deposits in an Individual Retirement Account and any other account that would lose special tax treatment under state or federal law if given as security are not subject to the security interest you have given in your shares and deposits. Primary Applicant Signature Please type your name below Co-Applicant Signature Please type your name below You may be required to sign a form in person at a future date. Security Code Please enter the security code below prior to submitting the form