Secure Loan Application

Fleur de Lis Federal Credit Union 433 Metairie Rd. Suite 114 Metairie, Louisiana 70005

IF THIS IS YOUR FIRST ZEST APPLICATION, PLEASE COMPLETE THE CONSUMER LOAN APPLICATION. 
THIS APPLICATION APPLIES TO ZEST RENEWALS ONLY.

TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING

Amount/Credit Limit Requested: $
Loan Type:
Loan Purpose:

PAYMENT PROTECTION COVERAGE
Check if desired

Find out more about Payment Protection Insurance and why it's a better consumer value when offered through your credit union.

Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you.
A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.

Yes No Do you want your loan protected for you and your family if you become disabled?

TELL US ABOUT YOURSELF

Applicant  
Name:
Email: 		 
CU Account #:  
Social Security #:  
Home Phone:
Business Phone: 		 
Present Address:



Years There: Own Rent 		 
Employer:  
Occupation: Supervisor:  
Date of Employment:  
Income: $ Net Gross Annual Monthly Bi-weekly Weekly
 
Other Income: (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.)
Source: $
Annual Monthly Hourly		  
Have you had one or more outstanding judgments? Yes No
In the last 10 years, have you been declared bankruptcy or had a debt adjustment plan? Yes No
Have you had a foreclosure or repossession in the last 7 years? Yes No
Are you a party in a lawsuit? Yes No
Are you other than a U.S. citizen or permanent resident alien? Yes No
Is your income likely to reduce in the next two years? Yes No
Are you a co-maker, co-signer, or guarantor on any loan not listed above? Yes No
References:
Name Nearest Relative:
Address:
Phone Number:
Name Closest Friend:
Address:
Phone Number:

You must submit copies of your latest two (2) paycheck stubs or recent w-2 to the credit union by mail, fax or personally.

By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify
us of any changes to your name, address or employment.

You authorize the credit union to obtain credit reports in connection with this request.

Please only submit your loan application one time.
If the Credit Union needs any additional information after receiving your application, we will contact you.
Thanks for your cooperation!
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Your savings is federaly insured to $250,000 NCUA (National Credit Union Administration) a U.S. goverment agency