| Amount Requested |
|
Collateral Offered
|
|
|
| Purpose of Loan |
|
|
|
| |
|
Date |
|
|
Personal
Information |
| Date |
|
Account
Number |
|
| Applicant's Name |
|
Address |
|
| Home Phone |
|
City,
State, Zip |
|
| Work Phone |
|
Social
Security Number |
|
| |
|
Birth Date |
|
| Co-Applicant's Name |
|
Co-Applicant's SS # |
|
| Home Phone |
|
Birth Date |
|
| Work Phone |
|
Relationship to Applicant |
|
|
Changes Since
Last Application |
| List all
Debts |
Balance |
Payment |
|
Mortgage/Rent |
|
|
|
Second Mortgage |
|
|
|
Child Support/Alimony |
|
|
|
All Other Debts |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
Applicant
Working?
Yes No |
Name of Employer |
|
Position |
| Address of
Employer |
|
Date hired |
|
Gross Income |
Co-Applicant
Working?
Yes No |
Name of Employer |
|
Position |
| Address of
Employer |
|
Date Hired |
| |
Gross Income |
|
Applicant
1) Co-Applicant
2) |
|
for Credit Union use ONLY |
| Approved: YES___ NO___
If Counter Offer, describe: |