I hereby apply for a loan of $___________ for a period of _________ months. I prefer the first payment to fall due on ________________. I likewise apply for such further loans or advances necessary to repay all additional indebtedness for taxes, insurance policies and renewals thereof, and repossessions, foreclosure and closing expenses.I likewise (apply for/do not apply for) such further advances as may be necessary to pay for Creditors Diasbility Insurance.
Purpose of Loan _____________________________________________

Secured Credit - Collateral:
Shares in Account Nos. _______________________________ $____________________________
New/Used Auto - Make ______________ Year _______________ Cost/Value $________________
Other __________________________________________________________________________
Owner's Name ___________________________________________________________________

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)

___ Unmarried

___ Married

___ Separated

Personal InformationFull Name _______________________________ Date of Birth ____________________ SS No. ___________________________
Drivers Lic. No. __________________ Street Address _______________________________ Years there _____________
City _______________________________________________________ State ____________________ Zip Code ________________
Home Phone __________________ Business Phone _________________ Present Employer __________________________
Years there ________ Position or Title _________________ Supervisor _________________________
Employer's Address __________________________________________________________________
City _______________________________________________________ State ____________________ Zip Code ________________
Dependents (exclude self) _______________________________ Ages _________________________
Name of nearest relative not living with you _______________________ Relationship______________
Address _________________________________________ Phone No. ________________________
Personal References __________________________________________________________________
Spouse's Name ______________________ Date of Birth ____________________ SS No. ______________________
Spouse's Employer ___________________________________________________________________ Income Information
(*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 loan.)Salary (___ Gross ___ Net) $________________ per ________________
*Other Income __________________ per ____________ Source ______________________________
Is any income listed likely to be reduced before this loan is paid off? ___ No ___ Yes
If yes, explain _______________________________________________________________________ If present residence less than 2 years, complete next 2 linesPrevious Street Address _____________________________________Years there _________________
City __________________________ State ______________________ Zip Code _________________ If employed by above less than 3 years, complete next 2 linesPrevious Employer _________________________________________Years there _________________
Previous Employer's Address ___________________________________________________________ Outstanding Debts ( List Everything)

Type	Creditor (Address and Acct. No.)	Loan Date	Orig. Debt	Present Balance	Monthly Payment	Past Due Yes/No
Rent
Mortgage
Auto Loan
Credit Union
Credit Card
Alimony, etc.
Other
Other
Other
Other
Totals

Are there any unsatisfied judgments against you? ___ Yes    ___ No
If yes, to whom? _____________________________________ Amount $___________________
Are there any other persons obligated on any of the above loans? ___ Yes    ___No
Which ones and who? ____________________________________________________________
Are you a co-maker, co-signer or guarantor on any loan? ___ Yes    ___ No
For whom? _____________________________ To whom? ______________________________
Have you been the subject of any order for relief under The Federal Bankruptcy Code or adjudicated a bankrupt under the Bankruptcy Act in the last 10 years? ___ Yes    ___ No

Everything that I have stated in this application is correct to the best of my knowledge. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.

Signature of Member ______________________________________ Date ____________________

For Credit Union Use OnlyLoan Officer:
____ I approved the loan as submitted.
____ Loan referred to C.C. Reason ______________________________________________________________
Loan Officer's Signature ___________________________________ Date ___________________

Credit Committee:
    ____ We approve the loan as submitted.
    ____ We reject the loan as submitted.
    ____ The following counter offer will be made to the applicant and if accepted, we approve the loan.
                 ____________________________________________________________________________________
                 ____________________________________________________________________________________
Specific reason(s) for rejection ___________________________________________________________________
Outside information considered __ No   __ Yes   (Describe)______________________________________________
Conditions, if any _____________________________________________________________________________
Signed _________________________________________________ Date _________________
Signed _________________________________________________ Date _________________
Signed _________________________________________________ Date _________________
    ____ ECOA notice and Reason for Rejection sent or delivered on ___________________.
    Signed _____________________________

Hand deliver, mail or fax your completed application to the credit union.