Secure Loan Application
PO Box 470, Monroe, NY 10949
Phone: (845) 774-0831  •  Fax: (845) 774-0835
Email: Info@orutilfcu.org


Type Of Loan Applying For

New or Used Auto Loan
Recreational Vehicle (Camper, ATV, Motorcycle, Boat, etc.)
Overdraft Line of Credit
Personal Loan

Share Secured Loan
Home Loans
Other:
Purpose of loan :
Requested Amount : $ .00  
Repayment Method : Coupons         Payroll Deduction          Automatic Transfer from CU Checking
Desired Length of Repayment : months.



Payment Protection Coverage
The Credit Union can quote you the cost without obligation. Select coverage(s) desired. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Single Credit Disability                                      Joint Credit Disability                                      None
Single Credit Life Insurance                              Joint Credit Life Insurance                              None



Applicant Information
Applicant's Name:
Member #:
Social Security #:
US Citizen: Yes No
Birthdate (MM/DD/YY):
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:
Email Address :
Cell Phone #:
Home Phone #:
Work Phone #:
Best Method to Contact:
Address :
City :
State:
Zip #:
Current Address since: (MM/YY)
Rent     Own     Payment:
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Member #:
Social Security #:
US Citizen: Yes No
Birthdate (MM/DD/YY):
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:
Email Address :
Cell Phone #:
Home Phone #:
Work Phone #:
Best Method to Contact:
Address :
City :
State:
Zip #:
Current Address since: (MM/YY)
Rent     Own     Payment:
If less than 3 yrs enter previous address:

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

Note: Alimony, child support or any other income need not to be revealed if you do not choose to have it considered as a basis for this credit request.

Debts & Assets
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: VIN: Description:
    
     Auto Year: Auto Make: VIN: 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 repossession in the last 7 years?
Is your income likely to decline in the next two years?
Do you have other loan applications pending at other financial institutions?
Are you co-maker/endorser on any loan not listed above?

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

Additional Comments

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 electronic signatures on this application and agree that your electronic 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 electronic signature.

Note: A current wage stub showing year-to-date information or other income documentation will be required for loan processing. Please send this to the credit union after submitting your application by email: info@orutilfcu.org or fax: (845) 774-0835.

By pressing the “Submit” 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.
Date:
Primary Signature:
Joint Signature:
Enter The Security Code Displayed In The Box Below:
[858932]