Borrowing Needs Please tell us how we can help you with your borrowing needs. Installment Loan Visa Credit Card (please check one) Visa Solicitation Agreement Consumer Credit Card Agreement & Disclosure Select loan type: Personal/Signature Auto Debt Consolidation Amount/Limit Requested $ Individual Application Joint Application (please check one) NEXT About Please tell us a little about yourself. First Name Last Name Middle Initial What is your member (account) number? What is your Social Security number? What is your date of birth? What is your driver license number? What state? -- AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Please list age of dependents. What is your Home phone number? What is your cell phone number? What is your work phone number? What is your email address? What is your current address? Address City State -- AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Do you: Own Rent (please check one) How long at this address? -- less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years+ What is your previous address? Address City State -- AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Do you: Own Rent (please check one) How long at this address? -- less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years+ Who do you pay mortgage/rent to: Balance (mortgage) 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) Do you serve or have served in Military? Yes No Start Date End Date Is duty station transfer expected during the next year? Yes No Where: Ending/Separation date Please tell us a little about the co-applicant. First Name Last Name Middle Initial Is Co-Applicant a member? Yes No If yes, what is the member (account) number What is Co-Applicant's Social Security number? What is Co-Applicant's date of birth? What is Co-Applicant's driver license number? What state? -- AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Please list age of dependents. Same as applicant What is Co-Applicant's Home phone number? What is Co-Applicant's cell phone number? What is Co-Applicant's work phone number? What is Co-Applicant's email address? What is Co-Applicant's current address? Same as applicant Address City State -- AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Do they: Own Rent (please check one) How long at this address? -- less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years+ What is Co-Applicant's previous address? Same as applicant Address City State -- AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Do they: Own Rent (please check one) How long at this address? -- less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years+ Who do they pay mortgage/rent to: Same as applicant Balance (mortgage) Monthly Payment Interest Rate % Complete for joint credit, secured credit or if they live in a community property state: Married Separated Unmarried (Single - Divorced - Widowed) Do they serve or have served in Military? Yes No Start Date End Date Is duty station transfer expected during the next year? Yes No Where: Ending/Separation date PREVIOUS NEXT Income Please tell us a about your income. I work: Full-Time Part-Time Retired (please check one) Number of hours/week? Start date of employment? Name and address of employer: Name Address City State -- AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip What is your employment income $ Weekly Bi-weekly Monthly (please check one) Your Title is? NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED. What is your other income $ Weekly Bi-weekly Monthly (please check one) What is the source of the other income? What was the name and address of your previous employer? (if employed less than 5 years at current employer) Name Address City State Zip Please Provide us 2 of your relatives living nearest to you: Relationship Name Phone Address City State Zip Relationship Name Phone Address City State Zip Please tell us a about the co-applicant's income. I work: Full-Time Part-Time Retired (please check one) Number of hours/week? Start date of employment? Name and address of employer: Name Address City State Zip What is Co-Applicant's employment income $ Weekly Bi-weekly Monthly (please check one) Co-Applicant's Title is? NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED. What is Co-Applicant's other income $ Weekly Bi-weekly Monthly (please check one) What is the source of the other income? What was the name and address of your previous employer? (if employed less than 5 years at current employer) Name Address City State Zip Please tell us a about what you owe? Please list debts in spaces below. Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Please tell us a about the co-applicant owes? (exclude accounts listed by applicant) Please list debts in spaces below. Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Debt Description Creditor Name Interest rate Balance Monthly Payment Please tell us a about what you own? Please list what you own in spaces below. Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Please tell us a about the co-applicant owns (exclude items listed by applicant) Please list what co-applicant owns in spaces below. Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No Asset Description Location or Financial Inst. Value Pledged as collateral Yes No PREVIOUS NEXT Other Other information about you 1. Are you a U.S. citizen or permanent resident alien? Yes No 2. Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit? Yes No 3. Is your income likely to decline in the next two years? Yes No 4. Are you a co-maker, co-signer or guarantor on any loan not listed above? Yes No For whom (name of others obligated on loan): To whom (name of creditor): Other information about the Co-Applicant 1. Are you a U.S. citizen or permanent resident alien? Yes No 2. Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit? Yes No 3. Is your income likely to decline in the next two years? Yes No 4. Are you a co-maker, co-signer or guarantor on any loan not listed above? Yes No For whom (name of others obligated on loan): To whom (name of creditor): Comments Comments: Disclosures Notice to Nebraska Residents: A credit agreement must be in writing to be enforceable under Nebraska law. To protect you and us from any misunderstandings or disappointments, any contract, promise, undertaking, or offer to forebear repayment of money or to make any other financial accommodation in connection with this loan of money or grant or extension of credit, or any amendment of, cancellation of, waiver of, or substitution for any or all of the terms or provisions of any instrument or document executed in connection with this loan of money or grant or extension of credit, must be in writing to be effective. Notice to New York Residents: New York residents may contact the New York State Department of Financial Services to obtain a comparative listing of credit card rates, fees, and grace periods. New York State Department of Financial Services: 1-800-342-3736 or www.dfs.ny.gov. Notice to Ohio Residents: 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. Notice to Wisconsin Residents: (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. 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 your credit card account. Shares and deposits in an IRA or 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. You may withdraw these other shares unless you are in default. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. For example, if you have an unpaid credit card balance, you agree we may use funds in your account(s) to pay any or all of the unpaid balance. By signing or otherwise authenticating below, you are affirmatively agreeing that you are aware that granting a security interest is a condition for the credit card and you intend to grant a security interest. You acknowledge and agree that your pledge does not apply during any periods when you are a covered borrower under the Military Lending Act. For clarity, you will not be deemed a covered borrower, and your pledge will apply, if: (i) you become obligated on a credit transaction or establish an account for credit when you are not a covered borrower; or (ii) you cease to be a covered borrower. By signing or otherwise authenticating below: 1. You promise that everything you have stated in this application is correct to the best of your knowledge, and that the above information is a complete listing of what you owe. 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 crime to willfully and deliberately provide incomplete or incorrect information in this application. 2. If you are applying for a credit card, you understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the Consumer Credit Card Agreement and Disclosure. By selecting the "I Agree" and submitting, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Agree" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third-party verification is necessary to validate your E-Signature, and that the lack of such certification or third-party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and the Credit Union. By selecting "I Agree", I consent to abide by the terms and policies as set forth by the credit union. Please refer to the disclosure links below for details. I agree Disclosures Electronic Communication Consent and Notice Privacy Notice Truth-In-Savings Disclosure Electronic Fund Transfers Your Ability To Withdraw Funds Terms and Conditions of your Account Common Features Signature (Enter Name) Co-Applicant Signature (Enter Name) PREVIOUS
