Secure Loan Application
Address: 1020 W. Olive Ave., Burbank, CA 91506
Phone: (818) 238-2950  •  Fax: (818) 238-2979
Account Number Amount Requested Type Of Loan Applying For Term
If A Member $ Months
PRIMARY APPLICANT JOINT APPLICANT
Name: First, Middle, Last
Social Security #:

Date of Birth:

Marital Status:
What Is Your Email Address?
Home Phone #:
Cell Phone #:
 
Name: First, Middle, Last
Social Security #:

Date of Birth:

Marital Status:
What Is Your Email Address?
Home Phone #:
Cell Phone #:
HOME ADDRESS? HOME ADDRESS?
Street:
City:
State:
Zip:
Years At Address: Rent or Own:
Monthly Housing Payment: $
 
Street:
City:
State:
Zip:
Years At Address: Rent or Own:
Monthly Housing Payment:  $
EMPLOYMENT EMPLOYMENT
Current Employer:
Business Phone:
Street:
City:
State:
Zip:
Job Title:
Date of Hire (MM/DD/YY):
(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.)
Gross Salary: $
Frequency:
Other Income: $
Frequency:
Source Of Income:
 
Current Employer:
Business Phone:
Street:
City:
State:
Zip:
Job Title:
Date of Hire (MM/DD/YY):
(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.)
Gross Salary: $
Frequency:
Other Income: $
Frequency:
Source Of Income:
REFERENCE REFERENCE
Nearest Relative:
Relationship:
Phone:
Address:
 
Nearest Relative:
Relationship:
Phone:
Address:
OTHER INFORMATION
Have You Filed For Bankruptcy?
Are You A U.S. Citizen Or Permanent Resident Alien?
Are You  A Co-Maker/Endorser On Any Loan?
If Yes, Then For Whom? Balance:
Do You Currently Have Any Outstanding Judgments Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?
Do You Have An Obligation To Pay Alimony/Child Support?
  If Yes, Amount $  per
PAYMENT METHOD
I Would Like A Payment Booklet.
I Would Like The Payment Transferred From My Account On The Day It Is Due.
  Account Number:
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 - Do you want your loan protected for you and your family if you become disabled?
No

 
COMPLETE THE FOLLOWING IF YOUR REQUEST IS FOR A VEHICLE
Type: N/A Purchase Vehicle Refinance Vehicle Year Of Vehicle:
   
Make:
Model:
Vehicle Mileage:
     
Purchase Price:
$
Down Payment:
$
Current Payment On Trade In:
$
     
I am interested in GAP and/or MRC Insurance on the loan. Yes No
 

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 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 Application" button below, you agree to the above statement. You understand that we may require additional information to finalize our credit decision and your signature on additional documents prior to disbursing any credit proceeds.