Northern Chautauqua Federal Credit Union



Northern Chautauqua Federal Credit UnionCredit ApplicationApplicant InformationINCOME VERIFICATION REQUIRED ON ALL LOANS FOR ALL MEMBERSLoan type: Amount Requested: Loan term:Loan Purpose:202565026670006731002984500Repayment: Payroll Deduction Cash2301875311150063502730500 Single Credit Disability Insurance Single Credit Life Insurance2305050285750095252603500 Joint Credit Disability Insurance Joint Credit Life InsuranceName:Date of birth:SSN:Phone:Current address:City:State:ZIP Code:OwnRent(Please circle)Monthly payment or rent:How long?Previous address:City:State:ZIP Code:OwnedRented(Please circle)Monthly payment or rent:How long?Employment InformationCurrent employer:Employer address:How long?Phone:E-mail:Fax:City:State:ZIP Code:Position:Hourly Salary(Please circle)Annual income:Previous employer:Address:How long?Phone:E-mail:Fax:City:State:ZIP Code:Position:HourlySalary(Please circle)Annual income:Name of a relative not residing with you:Address:Phone:City:State:ZIP Code:Relationship:Co-Applicant Information, if for a joint accountName:Date of birth:SSN:Phone:Current address:City:State:ZIP Code:OwnRent(Please circle)Monthly payment or rent:How long?Previous address:City:State:ZIP Code:OwnedRented(Please circle)Monthly payment or rent:How long?Employment InformationCurrent employer:Employer address:How long?Phone:E-mail:Fax:City:State:ZIP Code:Position:Hourly Salary(Please circle)Annual income:Previous employer:Address:Phone:E-mail:Fax:City:State:ZIP Code:Position:HourlySalary (Please circle)Annual income:Application Information ContinuedName of a relative not residing with you:Address:Phone:City:State:ZIP Code:Relationship:Credit CardsNameAccount no.Current balanceMonthly paymentMortgage CompanyAccount no.:Address:Auto LoansAuto loansAccount no.BalanceMonthly paymentOther Loans, Debts, or ObligationsDescriptionAccount no.AmountOther Assets or Sources of IncomeDescriptionAmount per month or valueAre you a U.S. Citizen or permanent resident Alien?6635753302000254003302000 YES NODo you currently have any outstanding judgements 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?666750107950002857510922000 YES NOIs your income likely to decline in the next two years?5588001270000-622301333500 YES NOAre you a co-maker,co-signer or guarantor on any loan not listed above?5619752921000-590553111500 YES NOI authorize Northern Chautauqua Federal Credit Union to verify the information provided on this form as to my credit and employment history.Signature of applicantDateSignature of co-applicant, if for joint accountDate ................
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