P.O. Box 29527, Greensboro, NC  27429-9527
Tel: (336) 332-5302  •  Fax: (336) 332-4103
Toll-Free: (888) 794-1001, Option 1
Secure Loan Application
1. Member Number

You must be an Acclaim Federal Credit Union member to apply for a loan.
Your Member Number can be found in the right hand corner of your statement or call us.
Not a member? Click here for a Member Application.
 
2 .Type Of Loan Applying For

New Auto/Motorcycle
Used Auto Loan
Recreational Vehicle
Personal Loan
           Purpose:
Promotional Loan

Savings Secured/Certificate Secured
Overdraft Line of Credit
MasterCard® Credit Card
               Credit Card Disclosure
Home Equity Line of Credit
               When Your Home Is On The Line
 
3. Payment Protection Plan           Optional Credit Insurance Disclosure
3.1 Would you like to protect your family in case of death?
Single Credit Life (for you)
Joint Credit Life (for you and your co-borrower)
None

3.2 Would you like to reduce your monthly expenses in case of illness or injury?
Single Credit Disability (for you)
None
 
4. Loan Terms
4.1 - Are you submitting individually or jointly?
4.2 - Desired loan amount: $
4.3 - Repayment term:
4.4 - Desired Payment schedule:
4.5 - If required will you provide collateral to secure this loan?
   4.5a - If yes please describe collateral:
(ie., yr, make, model)
   4.5b - What is the value of the collateral? $ .00
4.6 - Method of Payment:
 
5. Primary Applicant
5.1 - Name:
First: Middle: Last: Suffix:
5.2 - Social Security Number:

555-55-5555
  5.3 - Date of birth:

mm/dd/yy
5.4 - What is your e-mail address?
(Re-enter your e-mail address)
5.5 - Home Phone Number:
555-555-5555
5.6 - What is your home address?
Street: City: State: Zip:
5.7 - Rent/Own/Buying:
   5.7a - Payment Amount:
5.8 - Time at residence:
5.9 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
If Applying For An Individual Loan Click Here

6. Joint Applicant
6.1 - Joint Applicant Type:   
6.2 - Name:
First: Middle: Last: Suffix:
6.3 - Social Security Number:

555-55-5555
6.4 - Date of birth:

mm/dd/yy
6.5 - What is your e-mail address?
(Re-enter your e-mail address)
6.6 - Home Phone Number:
555-555-5555
6.7 - What is your home address?
Street: City: State: Zip:
6.8 - Rent/Own/Buying:
   6.8a - Payment Amount:
6.9 - Time at residence:
6.10 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
 
7. Employment Information - Applicant
7.1 - Current employer:
7.2 - Title or position:
7.3 - Are you self employed?
  7.3a - Type of Business
7.4 - Business phone number:
ext.
555-555-5555
7.5 - Date Started Position:
mm/dd/yy
7.6 - Salary: $ .00
7.7 - Other income: $ .00
  7.7a - Source of income:
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
If Applying For An Individual Loan Click Here

8. Employment Information - Joint Applicant
8.1 - Current employer:
8.2 - Title or position:
8.3 - Are you self employed?
  8.3a - Type of Business:
8.4 - Business phone number:
ext.
555-555-5555
8.5 - Date Started Position:
mm/dd/yy
8.6 - Salary: $ .00
8.7 - Other income: $ .00
  8.7a - Source of income:
(You do not need to provide information about alimony, child support, separate maintenance or other sources of income if you do not wish to have them considered as income.)
 
9. Debts & Assets
9.1 - Please tell us about your assets:
  9.1a - Cash or equivalent: $ .00
  9.1b - Market Value of Home you Own: $ .00
  9.1c - Other assets (excluding real-estate): $ .00
9.2 Please tell us about your debts:
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
9.3 - Have you filed for bankruptcy?
  9.3a - Has this bankruptcy been discharged over four years ago?
  9.3b - (If less than four years) What year was the bankruptcy discharged?
9.4 - Are you co-maker/endorser on any loan not listed above?
  9.4a - If yes then for whom?
  9.4b - If yes then to whom?
9.5 - Are you a U.S. citizen or permanent resident alien?
   
10. References
10.1 - Nearest Relative NOT Living with you:
  10.1a - Name:
First: Middle: Last: Suffix:
  10.1b - Home Phone Number:
555-555-5555
  10.1c - What is their home address?
Street: City: State: Zip:
  10.1d - What is the relationship?
   
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