O&R Utilities Employees Home Page

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

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.

Are you applying for individual or joint credit ?: Individual    Joint

Type: Auto    Recreational Vehicle    Overdraft Line of Credit Personal    Shared Secured Loan   
     Home Loans    Debt Consolidation    Other
Purpose of loan:

Amount Requested: $ .00       Collateral:

Repayment: Coupons Payroll Deduction Automatic Transfer from CU Checking
Desired Length of Repayment: months.


Payment Protection Coverage
Check coverage(s) desired. The Credit Union will disclose the cost of this voluntary insurance to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Single Death, Disability and Involuntary Unemployment Insurance       Single Death and Disability Insurance       Single Death Insurance
Joint Death, Disability and Involuntary Unemployment Insurance       Joint Death and Disability Insurance       Joint Death Insurance


Applicant Information
Applicant's Name:
Account #:
Social Security #:
Email:
US Citizen: Yes No
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 #:
Cell Phone #:
Work Phone #:
Street Address:
City: State:
Zip #:
Are you Renting? Yes No
Monthly Payment? $
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:
Joint Applicant's Name:
Account #:
Social Security #:
Email:
US Citizen: Yes No
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 #:
Cell Phone #:
Work Phone #:
Street Address:
City: State:
Zip #:
Are you Renting? Yes No
Monthly Payment? $
Current Address since: (MM/YY)
If less than 3 yrs enter previous address:


Employment Information
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Department:
Position:
Date Hired (MM/DD/YY):
Gross Income (Before Overtime)
Weekly Monthly Yearly
Income from Overtime ($):
Other Income ($): per Month
Other Income Source:
Complete if current employment is less than 2 years:
Previous Employers Name:
Yrs Employed:
Applicant Employer's Name:
Employer Phone #:
Employer Address:
Department:
Position:
Date Hired (MM/DD/YY):
Gross Income (Before Overtime)
Weekly Monthly Yearly
Income from Overtime ($):
Other Income ($): 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
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 $
Assets:
Description: Value:
    
Description: Value:
    
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?


Reference (Nearest relative not living with you)
First Name: Middle Name: Last Name: Suffix:
   Home Phone Number:
   555-555-5555
   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:
   555-555-5555
   What is their home address?
Street: City: State: Zip:
   What is the relationship?


Contact Method
  How would you prefer to be contacted? Home Phone Cell Phone Email Work Phone
 
  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.