Partiot CU Home Page

Secure Loan Application Form

   
Type Of Loan Applying For

Type:

Amount Requested: $ .00       Purpose: Desired Length of Term: Months

Repayment: Shares Drafts



Payment Protection Coverage

If you answer “yes”, the credit union will disclose the cost to protect your loan. The credit insurance is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.

Are you interested in having your loan protected? Yes       No


Applicant Information
Applicant's Name:
Account #:
Social Security #:
Email:
US Citizen: Yes No
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #:
Social Security #:
Email:
US Citizen: Yes No
Birthdate:
Please indicate your marital status if you are applying for joint credit, secured credit or if you live in a community property state:
Marital Status:
Home Phone #:
Cell Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:


Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:

NOTE: Alimony, child support, or separate maintenance income need not be revealed if You do not choose to have it considered as a basis for this credit request.


Debts & Assets

Please list all open Accounts with a balance.


Creditor Monthly Payment
Housing
Rent Own None
Creditor Monthly Payment
Housing
Rent Own None
These questions must be answered. If any answers are a yes, please explain:

Do you have other loan applications pending at other financial institutions? Yes No

Are there any outstanding legal judgments against you? Yes No

Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13? Yes No

Are you a party in a lawsuit? Yes No

Is your status other than U.S. Citizen or Permanent Resident Alien? Yes No

Do you have other obligations such as child support, alimony, or similar Liabilities? Yes No

Are you a co-maker, cosigner, or a guarantor on any loan not listed above? Yes No

Explanation:

Are there any other assets, liabilities, obligations or considerations that we should know about in reviewing this application?
Yes No

If yes please explain:



References (Nearest relative not living with you)
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


 
References
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


Submit Application

You agree that everything stated in this application is correct to the best of your knowledge. The Credit Union is authorized to investigate your creditworthiness, employment history, and to obtain a credit report and to answer questions about their credit experience with you. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default.

You authorize us to accept your facsimile signatures on this application and agree that your facsimile signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature.

By pressing the "Submit Form" button below, you agree to the above statement. You understand that we may require your signature on additional documents prior to disbursing any credit proceeds.