Loan Application - Embers Credit Union

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* Required Fields

General Information
Check below to indicate the type of account(s) and type of credit for which are applying. Married Applicants may apply for a separate account.
* Account/Loan:
Individual
Joint
* Amount Requested
* Purpose/Collateral
Repayment:
Coupon
Automatic Payment
Payroll deduction
Payment Protection
Payment Protection
Yes
No
Payment Protection Interested in:
Single Credit Disability Insurance
Single Credit Life Insurance
Joint Credit Disability Insurance
Joint 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.
Applicant
* Last Name
Middle Name
* First Name
* Account Number
* Social Security Number
List of Ages of Dependents Not Listed By Other Applicant (Excludes Staff)
* Date of Birth
* Date of Birth Month / * Date of Birth Day / * Date of Birth Year
* Home Phone Number
( * Home Phone Number 1 ) * Home Phone Number 2 - * Home Phone Number 3 ext * Home Phone Number Extension
Business Phone Number/Ext.
( Business Phone Number/Ext. 1 ) Business Phone Number/Ext. 2 - Business Phone Number/Ext. 3 ext Business Phone Number/Ext. Extension
Best Method of Contact
Home phone
Business phone
email
Best Time to Contact
AM
PM
Email Address
Present Address
* Street Address
* City
* State
* Zip Code
* Residence Type
Own
Rent
Years at this Address
Previous Address if less than 2 years
Street Address
City
State
Zip Code
ResidenceType
Own
Rent
Years at this Address
Complete for joint Credit, Secured Credit or if you live in a Community Property State
Married
Separated
Unmarried (Single-Divorced-Widowed)
Applicant - Employment/Income
Name of Employer
Address of Employer
Title/Grade
Job Start Date
Job Start Date Month / Job Start Date Day / Job Start Date Year
Hours at Work
If Self Employed, Type of Business
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.
Employment Income
Per
year
month
hour
Income Amount
Net
Gross
Other Income
Income is per
year
month
hour
Other Income Source
Previous Employer
If Employed Less Than 2 Years
Name
Address
Starting Date
Starting Date Month / Starting Date Day / Starting Date Year
Ending Date
Ending Date Month / Ending Date Day / Ending Date Year
Applicant Reference
Name and Address of Relative Not Living With You
Relationship
Home Phone
( Home Phone 1 ) Home Phone 2 - Home Phone 3 ext Home Phone Extension
Co-borrower
Last Name
Middle Name
First Name
Account Number
Social Security Number
List Ages of Dependents Not Listed by Applicant (Excludes Staff)
Date of Birth
Date of Birth Month / Date of Birth Day / Date of Birth Year
Home Phone Number
( Home Phone Number 1 ) Home Phone Number 2 - Home Phone Number 3 ext Home Phone Number Extension
Business Phone Number/Ext.
( Business Phone Number/Ext. 1 ) Business Phone Number/Ext. 2 - Business Phone Number/Ext. 3 ext Business Phone Number/Ext. Extension
Email Address
Present Address
Street Address
City
State
Zip Code
ResidenceType
Own
Rent
Years at this Address
Previous Address
Address
City
State
Zip
Residence Type
Own
Rent
Years at this Address
Complete for joint Credit, Secured Credit or if you live in a Community Property State
Married
Separated
Unmarried (Single-Divorced-Widowed)
Other - Employment/Income
Name of Employer
Address of Employer
Title/Grade
Start Date
Start Date Month / Start Date Day / Start Date Year
Hours at Work
If Self Employed, Type of Business
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.
Employment Income
Per
year
month
hour
Income Type
Net
Gross
Other Income
Income is per:
year
month
hour
Source
Previous Employer
If Employed Less Than 2 Years
Name
Address
Starting Date
Starting Date Month / Starting Date Day / Starting Date Year
Ending Date
Ending Date Month / Ending Date Day / Ending Date Year
What You Owe
Rent/Mortgage
Rent
First Mortgage
Creditor Name Other Than This Credit Union
Interest Rate
Present Balance
Monthly Payment
Owed By
Applicant
Other
Child Support / Alimony / Spousal Support
Are You Obligated to Pay Any
Monthly Payment
How many years left to pay?
Other Information About You - Applicant
IF YOU ANSWER YES TO ANY QUESTION OTHER THAN #1, EXPLAIN ON ANY ATTACHED SHEET
1. Are You A U.S. Citizen or Permanent Resident Alien?
Yes
No
2. Do You Currently Have Any Outstanding Judgements Or Have You Ever Filed For Bankruptcy Had A Debt Adjustment Plan Confirmed Under Chapter 18, Had Property Foreclosed Upon Or Repossessed In The Last 7 Years, Or Been A Party In A Lawsuit?
Yes
No
3. Is Your Income Likely To Decline In the Next Two Years?
Yes
No
4. Are You A Co-Maker, Co-Signer Or Guarantor On Any Loan Not Listed Above?
Yes
No
For Whom (Name of Others Obligated on Loan):
To Whom (Name of Creditor);
Other Information About You - Co-borrower
IF YOU ANSWER YES TO ANY QUESTION OTHER THAN #1, EXPLAIN ON ANY ATTACHED SHEET
1. Are You A U.S. Citizen or Permanent Resident Alien?
Yes
No
2. Do You Currently Have Any Outstanding Judgements Or Have You Ever Filed For Bankruptcy Had A Debt Adjustment Plan Confirmed Under Chapter 18, Had Property Foreclosed Upon Or Repossessed In The Last 7 Years, Or Been A Party In A Lawsuit?
Yes
No
3. Is Your Income Likely To Decline In the Next Two Years?
Yes
No
4. Are You A Co-Maker, Co-Signer Or Guarantor On Any Loan Not Listed Above?
Yes
No
For Whom (Name of Others Obligated on Loan):
To Whom (Name of Creditor):
Attach Explanation Sheet
State Law Notices
Ohio Residents Only: the Ohio laws against discrimination require that all creditors make credit 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 766.59, or course decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the terms, before the credit is granted or the account is opened. (2) Please initial below 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.
Signatures
You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of what you owe. 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, renewal or extension of the credit received. You understand that the Credit Union will reply 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.
Applicant Signature _______________________________
Other Signature _________________________________
Additional Comments:
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