Willow Island Federal Credit Union

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Date (MM/DD/YY): Completed By:

Borrower:

Name (First/MI/Last):
Marital Status: (includes singe, separated, divorced, widowed)
Birthdate (MM/DD/YY):
Social Security #:
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:

Co-Borrower:

Name (First/MI/Last):
Marital Status: (includes singe, separated, divorced, widowed)
Birthdate (MM/DD/YY):
Social Security #:
Home Phone #:
Cell Phone #:
Present Address:
Street:
City:
State & Zip:

 
Employer :
Length of Employment:
Annual Salary: $

Employer :
Length of Employment:
Annual Salary: $


I do not wish to furnish this information:

Ethnicity: Hispanic or Latino Not Hispanic or Latino

Race: American Indian or Alaskan Native
          Black or African American
          Asian

          White
          Native Hawaiian or other Pacific Islander

Sex:. Male Female

I do not wish to furnish this information:

Ethnicity: Hispanic or Latino Not Hispanic or Latino

Race: American Indian or Alaskan Native
          Black or African American
          Asian

          White
          Native Hawaiian or other Pacific Islander

Sex:. Male Female


Approximate Value of Property: $

Purpose of Loan:





$

 
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