Note No. Account No. Soc. Sec. No. APPLICATION FOR LOAN

[Pages:1]Note No. ________________

U.F.C.W. Local #72 Federal Credit Union

APPLICATION FOR LOAN

Account No. _________________ Soc. Sec. No. _________________

I, ________________________________, hereby apply for a loan of $______________ for a period of ________ months, to be repaid in _________ monthly/________ installments of $____________ each including interest. I prefer the first payment to fall due on _______________. I desire this loan for the following purpose (explain fully): ______________________________________________________________________ _____________________________________________________________________________________________________________________ Co-makers or security offered (if any): ______________________________________________________________________________________ I hereby certify that all statements made, including those below, are true and complete and submitted for the purpose of obtaining credit. I have no other debts. The credit union is authorized to check my credit and employment history and to answer questions about its experience with me.

___________________ Date

__________________________________ Signature of Applicant

Address _______________________________________________ City _________________________ State _________________

This information, including appropriate signature(s), is to be filled in by either the credit committee or loan officer, depending upon who acts upon this application.

On _________________, 20____, I/We approved a loan in the amount and on the conditions requested by the above applicant, except as follows (list any changes in amount, terms, or conditions): _____________________________________________________________________________

Approved by CREDIT COMMITTEE

Approved by LOAN OFFICER

________________________ ________________________ __________________________ (All committee members shown as present in the minutes of the meeting at which this application was approved must sign above.)

____________________________

APPLICANT'S STATEMENT

I am indebted to the following creditors (list all debts such as doctor bills, installments, loans, real estate mortgages, etc. Attach additional sheet if necessary.):

CREDITOR

MO. PAYMENT

AMT. OWING

Mortgage ______________________________________________

Home Equity ____________________________________________

Auto _________________________________________________

Auto _________________________________________________

Other _________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

Employed By

Address

_____________________________________________________

Years Employed

Position

_____________________________________________________

Salary (Gross Without Overtime)

Business Phone

$__________per________________________________________

Date of Birth Number of Dependents Home Phone

(exclude self)

_____________________________________________________

Auto(s) Owned Make

Year Model

_____________________________________________________

_____________________________________________________

Market Value

Monthly

Own Residence $ ___________ Rent Residence $ __________

References

_____________________________________________________

Other Pertinent Information

_____________________________________________________

_____________________________________________________

Other Income

_____________________________________________________

_____________________________________________________

CO-MAKER'S STATEMENT

___________________________________________________

NAME OF CO-MAKER

ADDRESS

I am indebted to the following creditors (list all debts such as doctor bills, installments, loans, real estate mortgages, etc. Attach additional sheet if necessary.):

CREDITOR

MO. PAYMENT AMT. OWING

Mortgage ___________________________________________

Home Equity _________________________________________

Auto ______________________________________________

Auto ______________________________________________

Other ______________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

Employed By

Address

__________________________________________________

Years Employed

Position

__________________________________________________

Salary (Gross Without Overtime)

Business Phone

$___________per____________________________________

Date of Birth Number of Dependents Home Phone

(exclude self)

___________________________________________________

Auto(s) Owned Make

Year Model

__________________________________________________

__________________________________________________

Market Value

Monthly

Own Residence $ ___________ Rent Residence $ _______

References

__________________________________________________

Other Income

__________________________________________________

Relation to Applicant (if any) ___________________________

Social Security Number _________________________________

I certify that the above statements are true and complete.

_____________________________________________________

Date

Signature of Co-Maker

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