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Getting Started

Loan Type:

AutoPersonalOverdraft Protection

Amount Requested:

Account Number:

Type of Credit Requested:

Individual Credit: Relying solely on my income or assets
Individual Credit: Relying on my income or assets as well as income or assets from other sources
Joint Credit: We intend to apply for joint credit

Primary Applicant

Personal Information

First Name:

Middle Name:

Last Name:

Marital Status:

MarriedUnmarriedSeparated

Social Security Number/TIN:

Date of Birth:

Email Address:

Home Phone:

Cell Phone:

Business Phone/Ext.:

Home Address Line 1:

Home Address Line 2:

City:

State:

ZIP Code:

Residence Type:

OwnRent

Time At Current Residence (Years):

Time At Current Residence (Months):

Mortgage Balance:

Monthly Housing payment:

Employment/Income

Current Employment:

Full TimePart TimeRetired

Employment Start Date:

Employer Name:

Employer Phone:

Employer Address:

Employer City:

Employer State:

Employer ZIP Code:

Position/Job Title:

Gross Salary:

Per Month or Year:

MonthYear

Other Income:

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 obligation.

Per Month or Year:

Per YearPer Month

Other Income Source:

If employed in current position less than three years, complete the following

Previous Employer's Name:

Previous Employer's Phone:

Previous Employer's Address:

Previous Employer's City:

Previous Employer's State:

Previous Employer's Zip Code:

Start Date:

End Date:

Questions

Citizenship Status:

US CitizenPermanent ResidentNon-Permanent Resident

Military Status:

NACurrent Active MemberRetired

Joint Applicant

Personal Information

First Name:

Middle Name:

Last Name:

Marital Status:

MarriedUnmarriedSeparated

Social Security Number/TIN:

Date of Birth:

Email Address:

Home Phone:

Cell Phone:

Business Phone/Ext.:

Home Address Line 1:

Home Address Line 2:

City:

State:

ZIP Code:

Residence Type:

OwnRent

Time At Current Residence (Years):

Time At Current Residence (Months):

Mortgage Balance:

Monthly Housing payment:

Employment/Income

Current Employment:

Full TimePart TimeRetired

Employment Start Date:

Employer Name:

Employer Phone:

Employer Address:

Employer City:

Employer State:

Employer ZIP Code:

Position/Job Title:

Gross Salary:

Per Month or Year:

MonthYear

Other Income:

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 obligation.

Per Month or Year:

Per YearPer Month

Other Income Source:

If employed in current position less than three years, complete the following

Previous Employer's Name:

Previous Employer's Phone:

Previous Employer's Address:

Previous Employer's City:

Previous Employer's State:

Previous Employer's Zip Code:

Start Date:

End Date:

Questions

Citizenship Status:

US CitizenPermanent ResidentNon-Permanent Resident

Military Status:

NACurrent Active MemberRetired

State Law Notices

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 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

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.
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.

Acknowledgement

By submitting this application, 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 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 and for other accounts, products, or services we may offer you or for which you may qualify. 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.