1807 Lincoln Way East, Massillon, OH 44646
Phone: 330-833-0751 • Fax: 330-833-2159
Secure Online Loan Application
1. Member Number

You must be a Superior Savings Credit Union member to apply for a loan.
 
2 .Type Of Loan Applying For

New Auto Loan
Used Auto Loan
Motorcycle

Personal Loan
Savings Secured
VISA Credit Card - Classic  (VISA Disclosure»)
 
3. Payment Protection Plan
3.1 Would you like to purchase Credit Life Insurance?
Single Credit Life (Only Available for Applicant)( Approximately 5.2¢ per $100.00 per month)
Joint Credit Life (Approximately 9.1¢ per $100.00 per month)
None

3.2 Would you like to purchase Single Credit Disability Insurance? (Ranges From .1390 To .4986 Per $100.00 Per Month)
Yes (Primary Member Only)
None
 
4. Loan Terms
4.1 - Are you submitting individually or jointly?
4.2 - Desired loan amount: $
4.3 - Repayment term:
4.4 - Desired Payment schedule:
4.5 - If required will you provide collateral to secure this loan?
   4.5a - If yes please describe collateral:
(ie., yr, make, model)
   4.5b - What is the value of the collateral? $ .00
4.6 - Method of Payment:
 
5. Primary Applicant
5.1 - Name:
First: Middle: Last: Suffix:
5.2 - Social Security Number:

555-55-5555
  5.3 - Date of birth:

mm/dd/yy
5.4 - What is your e-mail address?
(Re-enter your e-mail address)
5.5 - Home Phone Number:
555-555-5555
5.6 - Cell Phone Number:
555-555-5555
5.7 - What is your home address?
Street: City: State: Zip:
5.8 - Rent/Own/Buying:
   5.8a - Payment Amount:
   5.8b - Mortgage Company:
5.9 - Time at residence:
5.10 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
5.11 - Mother's Maiden Name:
If Applying For An Individual Loan Click Here

6. Joint Applicant
6.1 - Joint Applicant Type:   
6.2 - Joint Member Account (if one)
6.3 - Name:
First: Middle: Last: Suffix:
6.4 - Social Security Number:

555-55-5555
6.5 - Date of birth:

mm/dd/yy
6.6 - What is your e-mail address?
(Re-enter your e-mail address)
6.7 - Home Phone Number:
555-555-5555
6.8 - What is your home address?
Street: City: State: Zip:
6.9 - Rent/Own/Buying:
   6.9a - Payment Amount:
6.10 - Time at residence:
6.11 - Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
 
7. Employment Information - Applicant
7.1 - Current employer:
7.2 - Title or position:
7.3 - Are you self employed?
  7.3a - Type of Business
7.4 - Business phone number:
ext.
555-555-5555
7.5 - Date Started Position:
mm/dd/yy
(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.)
7.6 - Salary: $ .00
7.7 - Other income: $ .00
  7.7a - Source of income:
If Applying For An Individual Loan Click Here

8. Employment Information - Joint Applicant
8.1 - Current employer:
8.2 - Title or position:
8.3 - Are you self employed?
  8.3a - Type of Business:
8.4 - Business phone number:
ext.
555-555-5555
8.5 - Date Started Position:
mm/dd/yy
(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.)
8.6 - Salary: $ .00
8.7 - Other income: $ .00
  8.7a - Source of income:
 
9. Debts & Assets
9.1 - Please tell us about your assets:
  9.1a - Cash or equivalent: $ .00
  9.1b - Market Value of Home you Own: $ .00
  9.1c - Other assets (excluding real-estate): $ .00
9.2 Please tell us about your debts:
Lender
Type
Balance
Min. Pmt.
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
9.3 - Have you filed for bankruptcy?
  9.3a - Has this bankruptcy been discharged over four years ago?
  9.3b - (If less than four years) What year was the bankruptcy discharged?
9.4 - Are you co-maker/endorser on any loan not listed above?
  9.4a - If yes then for whom?
  9.4b - If yes then to whom?
9.5 - Are you a U.S. citizen or permanent resident alien?
   
10. References
10.1 - Nearest Relative NOT Living with you:
  10.1a - Name:
First: Middle: Last: Suffix:
  10.1b - Home Phone Number:
555-555-5555
  10.1c - What is their home address?
Street: City: State: Zip:
  10.1d - What is the relationship?

Identification Program As Required By The USA Patriot Act:
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What This Means For You:
We will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents. In some cases, identification will be requested for current account holders if original documentation was not obtained with the opening of the account.

We ask for your understanding as we work to support these efforts to maintain the security of your funds and our country.

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.

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