Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:

1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI),
2. your spouse will use the account, or
3. you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.

Joint Credit: If you are applying with another person, complete the Applicant and Other sections.

Guarantor: Complete the Other section if you are a guarantor on an account/loan.

Check below to indicate the type of account(s) and type of credit for which you are applying. Married applications may apply for a separate account.

LOANLINER Account/Loan: Amount Requested $: Purpose/Collateral:

Individual Joint

Provide information about both of you by completing Applicant and Co-Applicant sections. NOTE: The Credit Union cannot consider you as a co-borrower if you are not a Credit Union member. You will be considered a co-signer or guarantor unless you make arrangements to become a Credit Union member.

(Including ATM/Debit Card access to the account if Available)


Applicant

NAME (last - first - Initial) MOTHER'S MAIDEN NAME

ACCOUNT NUMBER

SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER / STATE /

BIRTH DATE

HOME PHONE

BUSINESS PHONE / EXT.

E-MAIL ADDRESS

PRESENT ADDRESS (Street - City - State - Zip)

OWN RENT

YEARS AT THIS ADDRESS

MORTGAGE/RENT OWED TO:

MORTGAGE BALANCE $ MONTHLY PAYMENT INTEREST RATE $

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
MARRIED SEPARATED UNMARRIED Single Divorced Widowed

EMPLOYMENT/INCOME

NAME AND ADDRESS OF EMPLOYER

START DATE

NOTICE: ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED

EMPLOYMENT INCOME $ PER NET GROSS

OTHER INCOME $ PER
SOURCE


Other Co-Applicant Spouse Guarantor

NAME (last - first - Initial) MOTHER'S MAIDEN NAME

ACCOUNT NUMBER SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER/STATE /

BIRTH DATE

HOME PHONE

BUSINESS PHONE / EXT.

E-MAIL ADDRESS

PRESENT ADDRESS (Street - City - State - Zip)

OWN RENT

YEARS AT THIS ADDRESS

MORTGAGE/RENT OWED TO:

MORTGAGE BALANCE $ MONTHLY PAYMENT INTEREST RATE $

COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STATE:
MARRIED SEPARATED UNMARRIED Single Divorced Widowed

EMPLOYMENT/INCOME

NAME AND ADDRESS OF EMPLOYER

START DATE

NOTICE: ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED

EMPLOYMENT INCOME
PER
NET GROSS

OTHER ICOME
$ PER
SOURCE


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 766.70, or court decree under 766.70 will adversely affect the rights of the Credit Union unless the Credit Unions 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.

By submitting this application to the Credit Union, 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 use in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and any update, increase, renewal or extension 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.

By submitting this application electronically, I/we agree to the same terms that apply to a signed application. If there is a co-applicant on this loan, that co-applicant has authorized the submission of this application. This electronic submission qualifies as my/our signature.