1444 E. Sunshine, Springfield, Mo 65804
Phone: (417) 820-2931 • Fax: (417) 820-8011
Secure Loan Application

Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Joint Applicant section about your spouse if:

  • Your spouse will use the account, or
  • 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 Joint Applicant section to the extent possible about the person on whose payments you are relying.

If you are applying for Joint Credit with another person, complete the Applicant and Joint Applicant sections.

1. Account Number

You must be a Mercy Credit Union member to apply for a loan.
 
2 .Type And Amount Of Credit You're Requesting
2.1 - Amount/Credit Limit Requested: $
2.2 - Loan Type:
2.3 - Purpose of loan:
2.4 - Security Offered: (Year, Make, Model)
2.5 - Are you submitting individually or jointly?
 
3. 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

 
4. Primary Applicant
4.1 - Name:
First: Middle: Last: Suffix:
4.2 - Social Security Number:

555-55-5555
  4.3 - Date of birth:

mm/dd/yy
4.4 - What is your e-mail address?
(Re-enter your e-mail address)
4.5 - Home Phone Number:
555-555-5555
4.6 - What is your home address?
Street: City: State: Zip:
4.7 - Rent/Own/Buying:
   4.7a - Payment Amount:
4.8 - Time at residence:
4.9 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
If Applying For An Individual Loan Click Here

5. Joint Applicant
5.1 - Joint Applicant Type:   
5.2 - Name:
First: Middle: Last: Suffix:
5.3 - Social Security Number:

555-55-5555
5.4 - Date of birth:

mm/dd/yy
5.4 - Home Phone Number:
555-555-5555
5.5 - What is your home address?
Street: City: State: Zip:
 
6. Employment Information - Applicant
6.1 - Current employer:
6.2 - Start Date: Full Time Part Time
6.3- Job Title:
6.4 - Business phone number:
ext.
555-555-5555
(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.)
6.5 - Gross Salary: $ .00
6.6 - Other income: $ .00
  6.6a - Source of income:
If Applying For An Individual Loan Click Here

7. Employment Information - Joint Applicant
7.1 - Current employer:
7.2 - Start Date: Full Time Part Time
7.3- Job Title:
7.4 - Business phone number:
ext.
555-555-5555
(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.)
7.5 - Gross Salary: $ .00
7.6 - Other income: $ .00
  7.6a - Source of income:
 
8. History
8.1 - Have you ever filed for bankruptcy?

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 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.

Note: A current wage stub showing year-to-date information, or other income documentation will be required for loan processing. Please fax this to (417) 820-7782 after submitting your loan application.

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.
   

Submit Application