Type and Amount of Credit You're Requesting

Is this your first loan from us?  Yes  No    Amount you are applying for: $
Approximate Time to Repay This Loan:  How Many?  Periods:  Years Months Weeks
Purpose of Loan: New Auto Purchase Used Auto Purchase Unsecured Loan New/Used Machinery Purchase New/Used RV Purchase New/Used Mobile Home Purchase Bill Consolidation Real Estate
Security Offered (please give complete description):

Type of Credit: Individual Credit Joint Credit

Payment Protection Coverage
Do you want your loan protected for you and your family if you become disabled?
Yes    No
We will disclose the cost of this Payment Protection (Credit Disability) Insurance to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

 Tell Us About Yourself
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state:   Married    Separated    Unmarried (Single - Divorced - Widowed)
Applicant Information

Name
FCCU Account #    SS #
Address
           
Years There:   Do you:   Own   Rent 
Home Phone:   Work Phone:   Birthdate
Employer's Name: 
Employer's Address: 
    (city/state)
Years on job:     Job Description:
Previous Employer (if current employment is less than 3 yrs.): 
How long:

INCOME:  Net Salary (after taxes): $ per Week Bi-week Semi-month Month
      Other Income: $ per Week Bi-week Semi-month Month Source:
(Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)

Proof of Income will be required before final approval can be made.

OUTSTANDING DEBTS: (loan payments, credit cards, alimony, child support, etc.)

Are you a co-signer on any other loan?  Yes   No    Monthly Payment $  
For Whom?

Have you declared Bankruptcy in the last 14 years?  Yes   No    When? 
Previous address (if current residence is less than 2 years:

Co-Applicant Information

Name
FCCU Account #    SS #
Address
           
Years There:   Do you:   Own   Rent 
Home Phone:   Work Phone:   Birthdate
Employer's Name: 
Employer's Address: 
    (city/state)
Years on job:     Job Description:
Previous Employer (if current employment is less than 3 yrs.): 
How long:

INCOME:  Net Salary (after taxes): $ per  Week Bi-week Semi-month Month                    
     Other Income: $ per Week Bi-week Semi-month Month Source:
(Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)

Proof of Income will be required before final approval can be made.

OUTSTANDING DEBTS: (loan payments, credit cards, alimony, child support, etc.)

Are you a co-signer on any other loan?  Yes    No   Monthly Payment $  
For Whom?

Have you declared Bankruptcy in the last 14 years?  Yes    No  When? 
Previous address (if current residence is less than 2 years:

Signatures:  you promise that everything you have stated in this request is correct to the best of your knowledge.  You authorize the credit union to obtain credit reports in connection with this request.

X______________________________  X______________________________
Applicant Signature & Date                                                    Co-Applicant Signature & Date

The credit union does not discriminate against any applicant.  By returning this loan application, you hereby request that the credit union proceed in assessing this application information for the purposes of extending credit to you.  If approved, you will need to sign further documents and disclosures.  

Please PRINT this form (using landscape format) and bring it with you to the Credit Union along with a recent pay stub and a sales agreement from the dealership.