CHEROKEE NATION TRIBAL LOAN PROGRAM



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Credit Builders Loan

QUALIFICATIONS:

Loan applicant must be an enrolled tribal member of Citizen Potawatomi Nation (CPN).

Applicants must be 18 years of age.

LOAN AMOUNT:

You may request any amount up to $1,000.

TERMS:

1. Maximum repayment terms: $200 to $999 – 12 months; $1,000 – up to 18 months.

2. Interest rate will be fixed at 10% (e.g. on a $1,000 note for one year the interest charge would be approximately $55, interest rate subject to change).

3. A Processing fee of $60.00 will be charged. A Credit Report fee of $15.00 may also apply.

APPLICATION:

1. Loan applicant must complete ALL of the boxes on the enclosed application.

2. List all “assets & liabilities”. This includes all types of payments made on a monthly basis.

3. Sign and date the application.

4. Include a copy of your CDIB, tribal enrollment card.

5. Fill out the Automatic ACH Authorization; attach a voided check for payments.

VERIFICATION:

1. Tribal Enrollment may be verified through tribal rolls.

PROCESSING:

1. Return all information to the Citizen Potawatomi Community Development Corporation we will review your request and notify you of decision within one week of receipt of application.

If you have any questions, please call (405) 878-4697.

1545 Gordon Cooper Drive, Shawnee, OK 74801

Phone: 405/878-4697 Fax: 405/878-4665

|CREDIT REPAIR CREDIT APPLICATION |

|SECTION A: INDIVIDUAL APPLICANT INFORMATION |

|NAME (Last, First, Middle) Ethnicity: Caucasian Hispanic/Latino |

|African American |

| |

|Asian/Other Pacific Islander Native American |

| |

|If Native American, what is your tribal affiliation? |

|PURPOSE OF LOAN (CIRLCE ONE) : |

| |

|ESTABLISH OR REESTABLISH CREDIT |

|LOAN AMOUNT REQUESTED: $ TERM REQUESTED: |

| |

|BIRTHDATE |TELEPHONE NO. |DRIVER’S LICENSE |SOCIAL SECURITY NO. |NO. OF DEPENDANTS |AGES OF DEPENDENTS |

| | | | | | |

|ADDRESS (street, City, State, Zip) |COUNTY |Do you | |Own |HOW LONG |

| | |or | |rent? | |

|PREVIOUS ADDRESS (Street, City, State, Zip) |COUNTY |Did you | |Own |HOW LONG |

| | |or | |rent? | |

|EMPLOYER (Company name and address) DEPARTMENT SUPERVISOR: CONTACT #-SUPERVISOR |HOW LONG |

| | |

|BUSINESS PHONE |Ext. |POSITION OR TITLE |SALARY PER MONTH |

| | | |Gross $ | |Net $ | |

|PREVIOUS EMPLOYER (Company name and address) |HIRE DATE |

| | |

|NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU |RELATIONSHIP |TELEPHONE NO. (include area code) |

| | | |

| | | |

|NAME AND ADDRESS OF NEAREST RELATIVE / FRIEND NOT LIVING WITH YOU |RELATIONSHIP |TELEPHONE NO. (include area code) |

| | | |

| | | |

| |

|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. |

| | |Court Order | |Written Agreement | |Oral Understanding |

|Alimony, child support, separate maintenance received under | | | | | | |

|OTHER EMPLOYMENT INCOME (EMPLOYER NAME, ADDRESS, PHONE NUMBER) |AMOUNT PER MONTH |

| | |

|SPOUSAL INCOME (EMPLOYER NAME ADDRESS, PHONE NUMBER) |AMOUNT PER MONTH |

| | |

|Is any income listed in this Section likely to be reduced before the credit request is paid off? |Have you previously received credit from us? |

| |No | |Yes (Explain) | |No | |Yes – when? |

|SECTION B: ASSETS |

| | |SUBJECT | |

|DESCRIPTION OF ASSETS |NAME IN WHICH ACCOUNT IS CARRIED |TO DEBT? |VALUE $ |

|CHECKING ACCOUNT NUMBER(S) | | | | |

|(INSTITUTION NAME) | | | |

|SAVINGS ACCOUNT NUMBER(S) | | | | |

|(INSTITUTION NAME) | | | |

|CERTIFICATE OF DEPOSIT(S) | | | | |

|(INSTITUTION NAME) | | | |

|MARKETABLE SECURITIES | | | |

|(Issuer, type, no. of shares) | | | |

|REAL ESTATE | | | |

|(location, date acquired) | | | |

|LIFE INSURANCE | | | |

|(Issuer, face value) | | | |

|AUTOMOBILES | | | |

|(make, model, year) | | | |

|OTHER: | | | |

|(list) | | | |

|TOTAL ASSETS | | | |

|OUTSTANDING DEBTS | |

| |(Including charge accounts, installment contracts, credit cards, rent, mortgage and other obligations. Use separate sheet if |

| |necessary.) |

| | | | | | |

|CREDITOR |ACCOUNT |NAME IN WHICH |ORIGINAL |PRESENT |MONTHLY |

| |NUMBER |THE ACCOUNT IS CARRIED |AMOUNT |BALANCE |PAYMENTS |

|Landlord or Mortgage Holder | |Rent Payment | | |(Omit Rent) |

| | | | |$ | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| |

|TOTAL DEBTS |

|Are you obligated to make Alimony, Support or Maintenance Payments? | |No | |Yes |

|If yes, to (Name & Address) | |Amt per month $ | |

|Are you a co-maker, endorser or guarantor on any loan or contract? |

Signatures: I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.

All parties understand and agree that the Citizen Potawatomi Nation Tribal Court has jurisdiction to resolve any dispute under the Credit Repair Loan Program of the Citizen Potawatomi Nation and the parties do herby submit to the personal jurisdiction of, and waive any objection to venue in, the Citizen Potawatomi Nation Tribal Court for the resolution of any dispute arising out of the credit repair loan program. The CPCDC reserves the right of offset.

All costs, fees, and expenses of collection and/or litigation will be charged to the “Borrower”, added to the balance of the loan, and withheld from the Loan proceeds held with the CPCDC.

_______________________________________________________

Applicant’s Signature Date

Would you like for us to review your credit report with you? __________

Are you interested in credit or budget counseling? _____________

For Office Use Only:

Approved by:

Credit Committee:

_____________________________________________ ____________________

Signature Title Date

_____________________________________________ ____________________

Signature Title Date

Automatic Bank Draft Authorization Form

Name: __________________________________________________________________

Address: ________________________________________________________________

City: ___________________________ State: ________ Zip Code: _________________

Daytime Phone: _________________ E-Mail Address: __________________________

Loan Number: __________________ Amount to be Withdrawn: $_________________

I authorize Citizen Potawatomi Community Development Corporation (CPCDC) to make

_____ One time deduction- on (date) ________________________________

_____ Monthly deduction –beginning (date) __________________________

from my ____checking ____savings account according to the terms listed below.

Bank Account Information: (Please attach a Voided Check)

Name on Bank Account: ___________________________________________________

Account Number: __________________ Routing Number: _______________________

Bank Name: ________________________________ Bank Phone: __________________

Bank Address: ___________________________________________________________

Bank Contact Name: ______________________________________________________

Signature of Applicant: __________________________________ Date: ____________

I authorize Citizen Potawatomi Community Development Corporation to draft my checking or savings account for payment of my loan obligation on a monthly basis unless stated otherwise, and for my financial institution to pay each amount from the account indicated no later than 5 days after billing. I understand I may cancel this authorization at any time by notifying the CPCDC in writing to remove my account from the monthly Automatic Bank Draft. The CPCDC will have 30 days to change my billing. I understand the CPCDC reserves the right to terminate my Automatic Bank Draft at any time upon written notice.

Office Use Only:

Received: ________________________Entered: ________________________________

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