Secure Loan Application Form

1407 Erbs Mill Road. Blue Bell, PA 19422
Phone: (610) 275-8440 | Fax: (610) 275-6473


Type Of Loan Applying For
Individual Credit: You must complete the Applicant section about yourself and the Other section about your spouse if:
1. you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI),
2. your spouse will use the account, or
3. you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying.
Joint Credit: Each Applicant must individually complete the appropriate section below, If Co-Borrower is spouse of the Applicant,- mark the Co-Applicant box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.
Check below to indicate the type of account(s) and type of credit for which you are applying. Married Applicants may apply for a separate account.
New Vehicle
Used Vehicle
Personal Loan
Home Equity Loan**
Unsecured Line of Credit**
Other:
**
other disclosures provided
Account / Loan: Individual Joint

Amount Requested: $ .00             Purpose / Collateral:
(Including ATM/ Debit Card Access to the Account if available)

Repayment:  Payroll Deduction Automatic Payment
 (If Automatic Payment, which account?)
Desired Length of Repayment:

Applicant Information
Applicant's Name:
Account #:
Driver License #:
Social Security #:
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 #:
Mobile Phone #:
Street Address:
City: State:
Zip #:
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #:
Driver License #:
Social Security #:
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 #:
Mobile 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:
Department (If Applicable):
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Joint App. Employer's Name:
Employer Phone #:
Employer Address:
Department (If Applicable):
Position:
Date Hired (MM/DD/YY):
Monthly Gross Income ($):
Other Income ($): per Month
Other Income Source:
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 (Applicant)
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Other Assets:
     Auto Year: Auto Make: Auto License Plate: Description:
    
     Auto Year: Auto Make: Auto License Plate: Description:
    
Have you ever filed for bankruptcy or had debt adjustment under Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesion in the last 7 years?
   Is your income likely to decline in the next two years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?
Are you a U.S. citizen or permanent resident alien?

Debts & Assets (Co-Applicant)
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
Child Support Payments / Alimony $
Other Assets:
     Auto Year: Auto Make: Auto License Plate: Description:
    
     Auto Year: Auto Make: Auto License Plate: Description:
    
Have you ever filed for bankruptcy or had debt adjustment under Chapter 13?
   Are you a party in a lawsuit?
   Have you ever had property foreclosed or repossesion in the last 7 years?
   Is your income likely to decline in the next two years?
Are you co-maker/endorser on any loan not listed above?
   If yes then for whom?
   If yes then to whom?
Are you a U.S. citizen or permanent resident alien?


Reference (Applicant)
First Name: Middle Name: Last Name: Suffix:
Home Phone Number:

555-555-5555
Cell Phone:

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

555-555-5555
Cell Phone:

555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?

Comment Box


Submit Application

You agree that everything stated in this application is correct to the best you 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.  Your understand that any false or misleading statement in our application ma cause any loan or extension of credit to be in default.  You authorize us to accept our electronic signature(s) on this application and agree that your electronic signature will hold the same legal force and effect as your original signature.  You assume any risk that may be associated with permitting us to accept our electronic signature.
By pressing the “Submit Application” 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.