| LOAN
APPLICATION |
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. |
| 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: |
|
Individual |
|
Joint |
Amount Requested $____________ |
Purpose/Collateral:_____________________ |
|
| (Including
ATM/Debit Card access to the account if Available) |
| Repayment:
|
|
Payroll
Deduction |
|
Cash
|
|
Military
Allotment |
|
Automatic
Payment |
|
Other
______________ |
|
|
| |
| |
Single
Credit Disability Insurance |
|
Single
Credit Life Insurance |
|
Joint
Credit Life Insurance |
| Check
coverage(s) desired. The credit union will disclose
the cost of this voluntary insurance to you. A separate
insurance election which discloses the terms and
conditions must be signed for coverage to become
effective. |
|
| |
| 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
|
| |
|
|
| 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 |
|
| NOTICE: : |
ALIMONY
CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME
NEED NOT BE REVEALED IF YOU DO NOT CHOOSE
TO HAVE IT CONSIDERED |
|
| EMPLOYMENT
INCOME |
OTHER
INCOME |
| $_______________ |
PER_______________ |
$_______________ |
PER_______________ |
| |
|
SOURCE______________________________ |
|
MILITARY:
IS DUTY STATION TRANSFER EXPECTED DURING NEXT
YEAR?
|
|
YES |
|
NO |
| WHERE
|
ENDING/SEPARATION
DATE |
|
NAME
AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU |
RELATIONSHIP
_______________
HOME PHONE
|
|
|
| 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
|
| |
|
|
| 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 |
|
| NOTICE: : |
ALIMONY
CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME
NEED NOT BE REVEALED IF YOU DO NOT CHOOSE
TO HAVE IT CONSIDERED |
|
| EMPLOYMENT
INCOME |
OTHER
INCOME |
| $_______________ |
PER_______________ |
$_______________ |
PER_______________ |
| |
|
SOURCE______________________________ |
|
MILITARY:
IS DUTY STATION TRANSFER EXPECTED DURING NEXT
YEAR?
|
|
YES |
|
NO |
| WHERE
|
ENDING/SEPARATION
DATE |
|
NAME
AND ADDRESS
OF NEAREST
RELATIVE NOT
LIVING WITH YOU |
RELATIONSHIP
_______________
HOME PHONE
|
|
|
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.
X_______________________________________________________________________________
SIGNATURE FOR WISCONSIN RESIDENTS ONLY Date
|
| |
1.
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.
2. 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.
3. 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 LOANLINER Credit and Security 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 to the interest you have given in your
shares and deposits. |
| X |
__________________________________________ |
X |
__________________________________________ |
| |
Applicants
Signature Date |
|
Other
Signature Date |
|
1.
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.
2. 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.
3. 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 LOANLINER Credit and Security 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 to the interest you have given in your
shares and deposits. |
| Credit
Insurance Enrollment Form/Schedule |
CUNA
MUTUAL INSURANCE SOCIETY •
MADISON,WI 53701-0391 • Phone:800/937-2644
"You"
or "Your" means the member and the joint insured
(if applicable).
Credit insurance is voluntary and not requried in order
to obtain this loan. You may select any insurer of your
choice. You can get this insurance only if you check the
"yes" box below and sign your name and write
in the date. The rate you are charged for the insurance
is subject to change. You will receive written notice
before any increase goes into effect. You have the rite
to stop this insurance by notifying your credit union
in writting. Your signature below means you agree that:
• If you elect insurance, you authorize
the credit union to add the charges for insurance to your
loan each month.
• You are eligible for insurance if
you are working for wages or profit for 25 hours a week
or more on the date of the initial advance. If you are
not, you will not be insured until you return to work
and complete an application for insurance. If you are
off work because of temporary layoff, strike or vacation,
but soon to resume, you will be considered at work.
•
If you are a homemaker, retiree or student,
you are eligible for Credit Life insurance only if you
are performing
all of the
usual
duties
of
a homemaker, retiree or student in the normal manner on
the date of the inital advance and you are not reciving
disability
benefits
from any source. Are you presently actively at work?
• You are eligible for insurance up
to the Maximum Age for Insurance. Insurance will stop
when you reach that age.
NOTE:
The Insurance you're applying for contains certain terms
and exclusions; Refer to your certificate for coverage
details
YOU
ELECT THE
FOLLOWING INSURANCE
COVERAGE(S) |
YES |
NO |
COST
PER $100
OF YOUR MONTHLY
LOAN BALANCE |
|
COVERED
MEMBER
(please print) |
| SINGLE
CREDIT DISABILITY |
|
23¢ |
| |
|
| SINGLE
CREDIT LIFE |
7¢ |
| JOINT
CREDIT LIFE |
10.5¢ |
|
|
| |
| |
| |
| If
you are totally disabled for more than 30 days,
then the disability benefit will begin with the
1st day of disabillity |
| ACCOUNT
NUMBER |
DATE
OF ISSUE OF THIS CERTIFICATE |
| |
|
|
| INSURANCE
MAXIMUMS |
DISABILITY |
LIFE |
| MAX.
MONTHLY TOTAL DISABILTY BENEFIT |
$
600 |
N/A |
| MAX.
INSURANCE BALANCE PER LOAN ACCOUNT |
$30,000 |
$30,000 |
| MAX.
AGE FOR INSURANCE |
66 |
71 |
|
| GROUP
POLICY NUMBER |
| 010-0354-3 |
|
| SECONDARY
BENEFICIARY (If you desire to name one) |
| |
|
|
DATE |
MEMBER'S
DATE OF BIRTH |
DATE |
JOINT
INSURED'S DATE OF BIRTH |
| |
|
|
|
|
|
| X |
__________________________________________ |
X |
__________________________________________ |
| |
Applicants
Signature Date |
|
Other
Signature Date |
| |
SIGNATURE
OF MEMBER
(Be sure to check one of the boxes above) |
|
SIGNATURE
OF JOINT INSURED (CO-BORROWER)
(Only requried if JOINT CREDIT LIFE coverage is
selected) |
|
| For
Credit Union Use Only |
| DATE |
|
APPROVED |
APPROVED
|
SIGNATURE |
LINE
OF CREDIT |
OTHER |
OTHER |
DEBT
RATIO/SCORE |
| |
|
DENIED
(Adverse Action Notice Sent) |
LIMITS: |
$ |
$ |
$ |
$ |
BEFORE
AFTER |
|
| LOAN
OFFICER COMMENTS: |
|
Signature:
X_______________________________________
Date
|
Signature:
X_______________________________________
Date
|
|
You
Must Print, Sign, and Return to Credit Union
|
