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Secure Loan Application
83 Merrimack Street, Lowell, MA 01852
Phone: (978) 328-5100 • Fax: (978) 458-8933

Please Enter Your Email Address:

How can we contact you: (phone# and times available)

If you are applying for joint credit with another person, complete the applicant and joint applicant section.
Individual Applicant Joint Applicant

Type of Loan Applied For:

Amount applied for $
Purpose:
Desired Length of Repayment (mos):

If applying for auto loan please supply the following:
Year:   Make:   Model:


Applicant:

US Citizen Yes No
Name:
Account #:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:

Number Of Dependents:

Joint Applicant:

US Citizen Yes No
Name:
Account #:
Relationship to Applicant:
Social Security #:
Birthdate (MM/DD/YY):
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Is applicant liable for alimony/child support: Yes No,  How much: $

Employment and Income: In order to expedite the processing of your loan application please fax your pay stub copies to (978) 458-8933, Attention: Loan Department. If self-employed or retired, financial statement or last years income tax return will be needed.
Employer Name:

Employer Phone #:
Date Hired (MM/DD/YY):
Monthly Gross Income $
Other Income: $ per Month
Employer Name:

Employer Phone #:
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:
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.

Credit Information
Please list all open Accounts with a balance.
Creditor Monthly
Payment
Housing
Rent , Own , None
$
If none Please explain:
$
$
$
$
Creditor Monthly
Payment
Housing
Rent , Own , None
$
If none Please explain:
$
$
$
$

References
Nearest Relative NOT Living with you:
Name:
First: Middle: Last:
Home Phone Number:     Work Phone Number:
What is their home address?
Street:
City: State:
Zip: What is the relationship?

Is your Income likely to decline in the next 2 years? Yes No
Have you ever filed bankruptcy or had a repossession? Yes No
Are you a cosigner on any other loan? Yes No
Are there any judgments or liens against you? Yes No

If a yes answer is given to any of the above questions, please provide an explanation below:


Home Loan Applicants please complete additional infomation:

Mortgage Information
Bank holding mortgage on home:
Mortgage Payment:$ Current year tax:
Original Mortgage Amount: $
Balance: $ Account: #
Market Value: $ Date Purchased:
Purchase Price: $ Primary Residence? Yes No
Does your first mortgage have a variable interest rate? Yes No
List all persons named on the deed:


Bank Accounts
Savings account bank: Savings balance $
Checking account bank: Checking balance $


Data Collection for Government Monitoring Purposes
The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws.  You are not required to furnish this information, but are encouraged to do so.  You may select one or more designations for “Race”.  The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it.  However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname.  If you do not wish to furnish the information, please check below.

APPLICANT:

I do not wish to furnish this information

Ethnicity: Hispanic or Latino, Not Hispanic or Latino

Race: American Indian or Alaska Native, Asian, Black or African American,
         Native Hawaiian or Other Pacific Islander, White

Sex: Female, Male


*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.
By filling out this application you agree to the following:
You promise that everything you have stated in this application is correct and to the best of your knowledge. If there are any important changes you will notify the credit union in writing immediately. You authorize the credit union to obtain credit reports in connection with this application for credit and for any update, renewal, extension, or collection of the credit received. You understand that the Credit Union may rely on the information on 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. You agree that your account will be subject to the terms and conditions of all applicable Loan Agreements and Disclosure Statements. You agree that a photocopy or facsimile of this application shall be as binding as the original. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federally insured financial institutions. A condition of your account is your granting us a security interest in your share accounts. By signing below you grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your loan. Shares and deposits in an Individual Retirement Account and any other account that would lose special tax treatment under state or federal law if given as security are not subject to this security interest. When you are in default we may apply the balance in these accounts to any amounts due under the loan agreement. You understand the credit union must verify all your income for prompt processing of your loan application, please attach a copy of your most recent pay stub and/or previous year’s tax returns.
If  you have applied for a Mills42 Federal Credit Union Visa Credit Card:
You understand that the use of your card will constitute acknowledgment of receipt and agreement to the terms of the credit card agreement and disclosures. You grant us a security interest in all individual and joint share and/or deposit accounts you have with us now and in the future to secure your credit card account. When you are in default, you authorize us to apply the balance in these accounts to any amounts due. Shares and deposits in an Individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security interest you have given in your shares and deposits.

     


IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

Mills42 Federal Credit Union is protecting your identity, as required by the USA Patriot Act.

To help our government fight the financing of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means to you:
When you open an account, we will ask you for your name, date of birth, current home address and Social Security Number or Taxpayer Identification Number, and other information that will help us identify you. We will also request a copy of a current photo ID, which clearly lists this information and a utility bill from your current address, preferably a phone bill.

In all cases, protection of our members’ identity and confidentiality is our pledge to you.

Thank you for your understanding and for joining us in securing a safer tomorrow for us all.

Mills42 Federal Credit Union © 2010  Privacy Policy