APPLICATION FOR CREDIT

Please note: this credit union complies with the Equal Opportunity Act.
Application Date: _______________________ Amount Requested: _________________________________
Member Acct. No.: _____________________ Reason for Credit Request: ____________________________

Information on Borrower:
First Name: __________________________________ Middle: __________________ Last: _______________________________________
Birth Date: _______________________Social Security No.: __________________________Home Phone: _________________________
Cell Phone: _______________________ E-mail Address: ________________________________________________
Street Address: _____________________________________________ City: _______________________ State: _______ Zip: ____________
Employer's Name: ___________________________________________ Position: ___________________ Time at Job (years): ______
Employer's Phone: ___________________________
Gross Monthly Income: _______________________ Is there a co-applicant? Yes ____ No _____
Other Monthly Income: _______________________ Source of Other Monthly Income: _____________________
Are you a US citizen? Yes _____ No _____

Information on Co-Applicant:
First Name: __________________________________ Middle: __________________ Last: ______________________________________
Birth Date: _______________________Social Security No.: __________________________Home Phone: ________________________
Cell Phone: _______________________ E-mail Address: ________________________________________________
Street Address: _____________________________________________ City: ________________________ State: ______ Zip: ____________
Employer'
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