Secure Loan Application
1811 Whipple Ave NW, Canton, Ohio 44708
Phone: (330) 478-8400  •  Fax: (330)478-8362
Loan Information
New Auto Loan
Used Auto Loan
Lease Look-Alike Loan
Recreational Vehicle (Boat, Camper, ATV, Motorcyle)
Signature Loan
Lot Loan
Home Equity Line of Credit
Second Mortgage Loan
Credit Rebuilder Loan
Share Secured Loan

Purpose of Loan Amount Requested Term
$ Months
PRIMARY APPLICANT   JOINT APPLICANT
Personal Information
Name: First, Middle, Last
Account Number If You Are A Member
Driver License Number
Social Security Number:
Date of Birth:
What Is Your Email Address?
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:
Personal Information:
Name: First, Middle, Last
Account Number
Driver License Number
Social Security Number:
Date of Birth:
What Is Your Email Address?
Home Phone Number:
Cell Phone Number:
I Can Be Best Reached Via:
Address
Street:
City:
State:
Zip:
Monthly Housing Payment: $
Rent/Own/Buying:
Time at residence:
 
Address
Street:
City:
State:
Zip:
Monthly Housing Payment:  $
Rent/Own/Buying:
Time at residence:
Employment
(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.)
Current Employer:
Business Phone:
Title or position:
Date Started Position:
mm/dd/yy
Gross Salary:
$
Frequency:
Other Income:
$
Frequency:
Source Of Income:
 
Employment
(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.)
Current Employer:
Business Phone:
Title or position:
Date Started Position:
mm/dd/yy
Gross Salary:
$
   
Frequency:
Other Income:
$
Frequency:
Source Of Income:
References
Nearest Relative (Not Spouse):
Phone:
Email:
Address:
 
References
Personal:
Phone:
Email:
Address:
Please Tell Us About Your Debts
Lender Type Balance Minimum Payment
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
$ .00 $ .00
Other Information
If this is a loan for a vehicle will any vehicles listed above be traded in? Yes No
Would you like to do automatic payments? Yes No
Check coverage (s) desired.  The credit union will disclose the cost of this voluntary insurance to you.  A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
Would you like to purchase Credit Disability Insurance? Yes None
Would you like to purchase Credit Life Insurance? Yes None
If application is for a vehicle loan, would you like to purchase Gap Insurance? Yes None
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 Judgements Or Have You Had A Debt Adjustment, Repossession, Or Property Foreclosed In The Last 7 Years Or Are A Party To A Lawsuit?

Additional Notes:  

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 based upon such false or misleading statement to be decalared 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. Security on one loan is security on any monies owed to the Credit Union.

PLEASE MAIL, FAX, OR BRING INTO TO OUR OFFICE YOUR MOST RECENT PAY CHECK STUB.

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.